Radiotherapy for trochanteric bursitis

Trochanteric bursitis is inflammation of the bursa near the outer hip, causing pain, tenderness, and stiffness. It often results from overuse or injury, with symptoms aggravated by hip movement. It may be surprising to some, but radiotherapy can be used to relieve symptoms. Dr Richard Shaffer is here to explain more about how radiotherapy can aid management of the condition.

What is trochanteric bursitis, and how can radiotherapy help in its management?

Trochanteric bursitis, also known as greater trochanteric pain syndrome (GTPS), is a condition that affects about 10% to 25% of people. It is particularly prevalent in women over the age of 50. Trochanteric bursitis, is thought to occur due to tears in certain muscles and tendons in your hip area. These tears, along with rubbing and friction, can lead to pain and discomfort.

Those suffering from the condition typically feel pain and tenderness around the outer part of their hip, which can cause pain which is so severe, that it can provoke difficulty sleeping or engaging in physical activities. In fact, the level of disability and the impact on the person's quality of life can be as severe as hip osteoarthritis, therefore it is crucial to find effective ways to manage and treat this condition.

Doctors occasionally use a low dose radiotherapy (LDRT) to help people suffering from GTPS, who have persistent or recurring pain. The objective of this treatment is to alleviate pain and enhance the functionality of the affected area. It has demonstrated effectiveness in approximately 65% of cases.

Are there alternative treatments for trochanteric bursitis, and how does radiotherapy compare?

Radiotherapy is a beneficial and non-surgical approach to alleviate pain and enhance functionality in individuals with this condition. In about 65% of cases, patients experience relief from their pain and symptoms.  Typically, doctors consider radiotherapy for patients who have not shown improvement with conservative treatments over a minimum of three months. Many of these individuals have previously attempted steroid injections before turning to radiotherapy.

The goal is to begin with less invasive treatments and move up the “treatment ladder” if the initial treatments do not work well. Generally radiotherapy is administered after conservative treatments have been used for a few months but have not proven effective. Surgery is only considered as a last resort, if pain persists despite other therapeutic methods.

What other treatment options are available? 

Other treatment options for trochanteric bursitis include the following:

Conservative Treatment

• Education + exercise: This means learning about the condition and doing exercises to reduce stress on the affected area and improve the underlying problem.

• Anti-Inflammatory medications: Taking medicine that reduces inflammation.

• Ice, rest, and stretching: Using ice, resting, and doing specific stretches to help with pain and healing.

 Medical Treatment

• Steroid injections: In some cases, doctors will use shots of steroids with local anaesthesia, often guided by ultrasound. These can provide short-term relief but might not work better than just watching and waiting.

• Other injections: Doctors may administer some other injections such as trigger point, platelet-rich plasma, or dry needling.

• Other methods: There are other treatments available such as infrared rays, shock wave therapy, ultrasound treatment, and hot or cold therapy.

Surgery

This involves removing the problematic bursa.

What are the potential side effects or risks associated with radiotherapy for trochanteric bursitis?

Due to the minimal dosage used in radiotherapy for GTPS, the associated side effects are generally mild. Individuals may encounter slight redness and mild discomfort in the skin, but these issues typically resolve quickly.

Regarding the potential risks associated with radiotherapy, it is crucial to understand that the doses employed are very low, typically ranging from 3 to 6 Gy in total. To provide context, when we use radiotherapy for cancer, the doses are much higher, typically between 50 and 80 Gy. For other non-cancer conditions, the dose is usually around 20 to 30 Gy.

There is a very small risk of developing radiation-induced cancers, which is estimated to be around 0.1% over the patient’s lifetime. The most common type of radiation-induced cancer is basal cell carcinoma, a type of cancer that rarely spreads. Furthermore, the likelihood of this cancer developing reduces as you get older.

How many sessions of radiotherapy are typically required for effective treatment?

During your treatment, you’ll visit the radiographer for six treatments over two to three weeks. During each treatment session the radiographer will help you get in the right position underneath the X-ray machine. The radiotherapy treatment is painless and takes less than one minute. All you have to do is make sure to keep still so that it’s accurate.

Each appointment takes around 10 minutes in total. Radiotherapy does not cause drowsiness or dizziness, therefore you are able to leave immediately and drive yourself home if needed.

Three months after your first radiotherapy course, you will visit your consultant again so they can see how you responded to treatment. Most people need another six sessions for full relief, but if your symptoms have already gone, you can choose to finish treatment after just one course.

Finally, you will have another follow-up after the second treatment course to discuss your outcomes and any next steps needed.

Can radiotherapy be used in combination with other therapies for better outcomes?

Yes, we recommend that you continue to do exercises and stretching alongside the radiotherapy treatment, as this is more likely to produce better results.

If you would like to book a consultation with Dr Shaffer, do not hesitate to do so by visiting his Top Doctors profile today.