Managing Hip Bursitis Pain

I am in physical therapy for my lower back and left hip. I do the exercises at home, and it seems to help a little. I will try heat pads. The pain is really bad in the mornings. I don't really like taking pain medication, because it upsets my stomach. I pray a lot and hope for relief.

@pwcook1 When I get a flare of bursitis in my hip, my treatment of choice, recommended by both the orthopedist and physical therapist, is ICE, not heat. The PT explained that while heat may feel soothing, ice is more therapeutic because it actually relieves the inflammation.

Lidocaine patches or topical Voltaren gel help me when it gets really bad, especially on days when I have to keep moving

Hi, I just found this group. (I am part of the kidney group.) I have been having discussions the a Facebook bursitis group for about four years. I was diagnosed with bursitis in 2022 by a Pain Management Specialist who used physical examination coupled with x-rays. I learned from the FB group that the optimal imaging for "seeing" bursitis is MRI but because I had an incompatible implant, that was not possible. That specialist recommended cortisone shots into the bursa because the only analgesic my nephrologist permits is tylenol which you will not be surprised to hear did nothing for my pain. So I let him do a cortisone injection into the bursa of my more painful leg. It was a miracle that lasted a few months. I then had the shots into both legs. Again, the miracle occurred.

But the third round was a complete failure. I then went to see an orthopedist who took new x-rays. The radiologist wrote that both of my hips had advanced osteoarthritis (the report accompanying the earlier x-rays had characterized it as mild OA). Total bilateral hip replacement was recommended. It's hard to say how effective the first surgery was because at PT on Day 5 after surgery, my femur cracked. As I recall the post-surgery pain up to that point was not the same as I had been having before surgery. Unfortunately, a gate keeper nurse on the orthopedist's "team" would only offer that opinion (without seeing me), via messages on the patient portal, that I was not carrying out the self care the brochure I had been given outlined. Of course that was not true but after two attempts to convince that nurse otherwise, I just put up and shut up.

At the six week post-op appt with the orthopedist (that I went to on crutches), new x-rays were taken which said show that I had suffered a cracked femur which was now healing. (I googled "cracked femur after hip replacement" but apparently I am a unique case. The only "hits" I got were medical journal articles outlining cases of broken femurs decades after hip replacement.)

I am not sure what possessed me. I should have settled for this outcome. But I decided to have the second hip replacement when the orthopedist described how the crack could be prevented by wrapping the femur with titanium wire. Fortunately, that worked.

Unfortunately, I continued to have so much pain that the PT's sent me home to recover more before attempting the exercises they wanted to teach me. That went on for a year. I had so much regret.

But then in Oct 2025 (over a year after the second hip replacement), I had what I thought might be my second gout flare in the same or neighboring toe as the first one in 2022. I had a bottle of colchicine, the gout specific analgesic, so I took a dose. I figured that if the pain diminished, I was right. If it didn't, I see my "gout" doctor (a nephrologist because rheumatology didn't believe I had gout since only uric acid was high, I had a sore, red, swollen toe for 3 months that was not broken. Rheumatology wanted a tophus to test. I didn't have one so no appt could be made.)

The best part of taking a trial dose of colchicine was not the total toe pain relief but that within a few hours, my hip pain VANISHED! So I have gout in my pelvis. A Dual Scan CT showed I also have pseudogout (aka chondrocalcinosis) in my pelvis. And as an amazing coincidence, pseudogout pain is one of three conditions that colchicine helps with pain relief. The other is Familial Mediterranean Fever which as a person of Japanese descent seemed unlikely to be my problem.

So 18 months after my first hip replacement, I made the PT appointment to learn the exercises I should do to recover. Two months later, for the first time in 5+ years, I was able to walk three miles on a mostly flat trail.

My conclusion is that hip pain is hard to diagnose. I hope you have faster results that I did. Next week is a planned trial of bike riding. I haven't been able to dismount alone since 2019. Hopeful.

I almost forgot. The orthopedist told me no more bursa cortisone shots. He reported seeing "too many" torn tendons in patients who had "too many" of those shots.

@mnsansei - those shots will give you osteoporosis!! Get a $1.25 gel pack at dollar tree-microwave 25seconds-stick in pants waitlist band/or freeze-stop oain

@smilton Are you saying that in addition to torn tendons, bursa cortisone shots will cause osteoporosis?

Fingers crossed that my hip problem is under control for now (having had hip replacement plus the diagnosis of gout and pseudogout whose pain is managed by colchicine) so cortisone is off the table.

@heyjoe415 Thank you for empathizing with me. I think my pain killer restrictions are the same as for all of us who have a chronic kidney disease. Aspirin is a NSAID, too.

I think either hip bursitis is in remission or I was wrongly diagnosed. I still have hip pain but a new reason: pseudogout aka chondrocalcinosis. Like gout (which I also have) it's another form of arthritis. I had bilateral total hip replacement for advanced osteoarthritis. After a very long, incomplete convalescence, my nephrologist sent me to have a Dual Scan CT which revealed deposits of pseudogout throughout my pelvis. I was still limping along and unable to take the long walks we enjoyed.

Then I had my second ever gout flare. I have a bottle of the gout painkiller colchicine on hand so I took it even though I wasn't sure it _was_ a gout flare. I was right and the toe stopped hurting within hours. To my complete surprise, my hip pain faded away because colchicine is also effective for pseudogout. I was finally able to do the PT I was supposed to start 17 months earlier on Day 5 after the first hip surgery. I'm about half way through the expected number of PT sessions and am feeling much stronger and more flexible. I was able to walk three miles about a month ago. Hurray!

I do wonder if hip pain, including bursitis, is difficult to diagnose and incorrect diagnoses make for persistent pain.

I'm very happy to hear you finally got some relief from the pain you've been in and were able to walk 3 miles. That's terrific and good for you!

I'm not sure if the bursa is removed with a total hip replacement. I did just one search and its inconclusive - so your best route is to ask your surgeon. I've had both knees, right hip and left shoulder replaced, and they do remove a number of physical structures - for ex - in a total knee replacement, the ACL and PCL tendons are usually removed, especially for older patients, like me!

As for your final question - a diagnosis of bursitis v arthritis causing pain in the hip is best asked of the surgeon. I do know that when my right hip became very arthritic (and ready for replacement) I had pain in my right groin (the hip joint actually sits under the groin).

The bursa I think you're talking about is on the outside of the hip, if it's still there……

Sorry I can't be of more help. You sound like a persistent person who works very hard to understand and fix any physical problems. There are too few of you in the world!

Again, congrats on finding a solution to your pain (colchicine) and for getting back to hip-replacement rehab. I know you will do very well!

Joe

@mnsansei Not mnsansei here, but EXCESSIVE use of oral or injected steroids (like cortisone or prednisone) MAY cause osteoporosis in some individuals. The risk all depends on the person, the dosage, the frequency, and to some extent, the expertise of the person giving the injections.

In my case, periodic cortisone injections for severe joint inflammation and oral prednisone for asthma and inflammation have been part of my life for over 30 years. My doctors are careful to use it only when really needed. I am female, over 70, with a small frame and a family history of osteoporosis, but as of my last DEXA scan, I have not developed osteoporosis or osteopenia.

So, as with all medications, the risks and benefits must be carefully weighed. My orthopedic doctor and I just discussed this very issue yesterday, as disk degeneration is leading to a decision point - do I live with debilitating pain, have spinal surgery that often is only successful for a few years, or treat with x-ray guided, targeted cortisone injections? Based on his expert recommendation and my experience, I am likely to try the injections first.

I'm very happy to hear you finally got some relief from the pain you've been in and were able to walk 3 miles. That's terrific and good for you!

I'm not sure if the bursa is removed with a total hip replacement. I did just one search and its inconclusive - so your best route is to ask your surgeon. I've had both knees, right hip and left shoulder replaced, and they do remove a number of physical structures - for ex - in a total knee replacement, the ACL and PCL tendons are usually removed, especially for older patients, like me!

As for your final question - a diagnosis of bursitis v arthritis causing pain in the hip is best asked of the surgeon. I do know that when my right hip became very arthritic (and ready for replacement) I had pain in my right groin (the hip joint actually sits under the groin).

The bursa I think you're talking about is on the outside of the hip, if it's still there……

Sorry I can't be of more help. You sound like a persistent person who works very hard to understand and fix any physical problems. There are too few of you in the world!

Again, congrats on finding a solution to your pain (colchicine) and for getting back to hip-replacement rehab. I know you will do very well!

Joe