What is a Trochanteric Bursectomy with Iliotibial Band Release?
A bursa is a fluid-filled sac that functions as a gliding surface to reduce friction between tissues of the body. The hip bone has a bony prominence that can be felt on the side of the hip which is known as the greater trochanter. The trochanteric bursa is located over this bony prominence, and is the bursa that is most commonly inflamed around the hip.
The biggest of the gluteal or ‘buttock muscles’ has a tendon that folds over the greater trochanter and joins a fibrous band that runs down the side of the thigh. This fibrous band is known as the iliotibial band or ITB. This fibrous band may become tight and contribute to irritation of the trochanteric bursa.
Trochanteric bursitis causes pain to be felt on the side of your hip which may be particularly felt at night if sleeping on the affected side.
Although most patients respond to corticosteroid injections, rest, physiotherapy, stretching, and anti-inflammatory medications, those with persistent symptoms may require an operation.
The operation involves removing the inflamed bursae and releasing the tension in the iliotibial band by making an incision in the band where it crosses the greater trochanter.
Who is this operation for?
Most cases of trochanteric bursitis will respond to non-surgical treatments. There are a number of treatment options which have shown to be effective including:
- corticosteroid injections
- rest
- physiotherapy
- stretching
- anti-inflammatory medication
The trochanteric bursectomy and ITB release surgery is only for patients who have tried the non-surgical options and have not had any relief from their pain. Very few patients who suffer trochanteric bursitis eventually go on to require surgery.
Complications
This surgical procedure is relatively non-invasive and does not carry a high complication rate. The general surgical complications still apply and include:
The main complication for this surgery is that the pain remains following the surgery. This is an uncommon complication.
Before the operation
Preadmission Clinic | Preparing for Surgery
Before your operation, you will be seen at the Preadmission clinic to make sure you are fit for the operation and all the necessary tests are performed in preparation for the operation.
During the visit, you will be seen by a
- doctor
- nurse
- anaesthetist (if necessary)
Tests
Tests that may be ordered for you include:
- blood tests
- Xrays
- Hip and Pelvis
- Chest
- Urine Test
- ECG
Preparing Your Skin
Your skin should not have any infections or irritations before surgery. If either is present, contact your orthopaedic surgeon for a program to improve your skin before surgery.
Tip
Carry a list of your medications with you including the name, dosage and how often you take it.
Medications
Our doctors will advise you which medications you should stop or can continue taking before surgery.
Get some help from your friends and family
Although you will be able to walk with crutches or a walker soon after surgery, you will need some help for several weeks with such tasks as cooking, shopping, bathing, and laundry. If you live alone, your orthopaedic surgeon’s office, a social worker, or a discharge planner at the hospital can help you make advance arrangements to have someone assist you at your home. A short stay in an extended-care facility during your recovery after surgery also may be arranged.
About the Operation
Anesthetic
There are two options for anesthesia for this surgery as it is a relatively minor operation:
- a general anesthetic (one that puts you to sleep)
- a regional anesthetic (one that numbs the area to be worked on)
For this surgery the regional anesthetic may either be a spinal block or an epidural. Both of these methods numb the body from the waist down.
Either type of anesthetic can be used to perform this procedure and may be discussed with your surgeon prior to the operation.
The operation
This operation can be carried out using arthroscopic or ‘keyhole’ surgery. It can also be performed with an open approach. The open approach means a larger incision in the skin is made in order to expose the tissues being operated on.
- Open approach: To begin the surgical procedure, a single incision is made in the side of the thigh over the area of the greater trochanter which is usually 5-10cm long.
- Arthroscopic approach: Usually 2 incisions about 1 cm wide are made around the side of your hip. Special cameras and surgical instruments are passed through this incisions to perform your operation.
Both approaches then follow the same procedure:
- The iliotibial band is split so that the trochanteric bursa and the bone of the greater trochanter can be seen. The tendon is split vertically. The inflamed bursae is removed. The bone of the greater trochanter is smoothed, and any bone spurs are removed.
- The skin is closed with stitches.
- The iliotibial band will eventually heal, with scar tissue joining the loose edges of the tendon. As it heals, it will be looser than before surgery, so it won’t rub on the greater trochanter quite so much.
After the Operation
After the operation, you are cared for in the Theatre Recovery room. You will usually only spend 1-2 hours in the recovery room.
Most people wake up fully when back in their rooms on the ward. Whilst on the ward, the nurses will take care of your every need. It usually takes a few hours to recover fully from the anaesthetic, and the nurse with regularly check on your recovery.
Try to avoid a lot of activity within the first week after surgery. Support your outer hip with a pillow when you sit or recline. During this time, you may also be instructed to use crutches to keep from placing weight on your hip while you stand or walk.
Recovery and Rehabilitation
Most people can go home the next morning. You will need someone to drive you home and attend to you, especially on the first night after surgery. You can also expect to be on crutches, or a walker, for at least a week.
It is normal to feel some discomfort and perhaps some swelling in the hip area.
It is important to see the physiotherapy team who will provide a rehabilitation program. A full regimen of return to sport and work will be tailored to your needs by our physiotherapy team. In general:
Rehabilitation after surgery can be a slow process. You will probably need to attend physical therapy sessions for several weeks, and you should expect full recovery to take several months. Getting the hip moving as soon as possible is important. However, this must be balanced with the need to protect the healing muscles and tissues.
Treatments include range-of-motion exercises and gradually work into active stretching and strengthening. Active therapy starts two to three weeks after surgery.
Are there important things I need to tell my doctors?
It is important to let your doctor know if you experience any of the following symptoms:
- Redness, swelling or warmth around the incisions
- Leakage from the incisions
- Fever and chills
- Severe hip pain that is not relieved by prescribed painkillers
- Loss of control over leg movement
- Loss of leg movement