Treatment of Chronic Hip Trochanteric Bursitis and Gluteal Tendinopathy

Introduction to Guideline Recommendations

• The American College of Rheumatology/Arthritis Foundation strongly recommends against PRP for hip osteoarthritis due to lack of standardization and insufficient evidence, but gluteal tendinopathy is a distinct pathology from hip osteoarthritis 1, 2

Diagnostic Considerations

• Ultrasound or MRI confirmation of gluteus medius/minimus tendinopathy with intratendinous pathology is necessary for diagnosis 3
• It is essential to rule out hip osteoarthritis, which would change the treatment paradigm, and exclude full-thickness tendon tears 3, 1

Treatment Algorithm

• Minimum 3-6 months of conservative therapy including relative rest, NSAIDs, and eccentric strengthening exercises should be documented before considering injection therapy 4
• The American Academy of Family Physicians recommends a minimum of 3-6 months of conservative therapy for patients with gluteal tendinopathy 4

Injection Therapy

• Leukocyte-rich PRP injection is recommended for gluteal tendinopathy, as it provides superior pain relief and functional improvement compared to corticosteroid injection 1, 2
• The American College of Rheumatology recommends against PRP for hip osteoarthritis, but this does not apply to periarticular tendinopathy 1, 2

Expected Outcomes and Durability

• PRP benefits continue improving through 2 years, with 64.1% of PRP patients achieving modified Harris Hip Score (mHHS) ≥74 vs. 45.9% with corticosteroid 4
• Corticosteroid benefits peak at 6 weeks and decline thereafter, with 82% of PRP patients achieving minimal clinically important difference (MCID >8 points) vs. 56.7% with corticosteroid 4

Patient Selection and Standardization

• Evidence is strongest for patients with symptoms >4 months, and patients with full-thickness gluteal tendon tears should be excluded 4
• The use of leukocyte-rich PRP specifically is recommended, as preparation methods vary widely 1, 5