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I am in good health but getting up there in age (72 this month!). I had a hip replacement two years ago that seems to be working fine. But I've come up lame lately with pain along the side of my hip. An X-ray of the new hip joint shows it is just fine. What else could be causing this problem?

Pain along the side of the hip is still a common spot for bursitis (also known as greater trochanter pain syndrome. A large tendon passes over the bony bump on the side of the hip called the greater trochanter. Inflammation in the bursa (a protective gel sac) between the tendon and the greater trochanter is called trochanteric bursitis or lateral hip bursitis. You can see there are many names for this problem. Hip bursitis is common in older individuals. Women seem affected more often than men. Pain associated with this problem is often made worse by lying directly on the hip, walking, or going up stairs or steep inclines. It may not be possible to walk without a limp because of the pain. The muscles involved most often include the gluteus minimus and the gluteus medius, the so-called rotator cuff muscles of the hip. There are three types of hip rotator cuff tears that can cause lateral hip bursitis: 1) degenerative or traumatic tears seen most often in older adults, 2) nonpainful tears associated hip fractures or hip osteoarthritis, and 3) tendon avulsion (tendon is not just torn but pulled completely away from the bone). Other causes of lateral hip pain can be hip osteoarthritis, an undetected hip fracture, nerve injury, or problem in the lumbar spine (low back) such as stenosis or spondylosis. The surgeon uses certain clinical tests (e.g., hip range-of-motion, straight leg raise) and imaging studies (e.g., X-rays, MRIs) to sort out what's really going on in the hip. MRIs are especially helpful in seeing the condition of the tendons and muscles and identifying partial tears from full-thickness tears and avulsion injuries of the gluteal muscles. Individuals who have had a previous total hip replacement may develop lateral hip pain from tendon avulsion, which will show up on an MRI. Treatment early on can prevent this painful condition from becoming a chronic problem that might require surgery. The effectiveness of conservative (nonoperative) care depends on a correct diagnosis and assessment of the severity of the underlying tendon injury. Short-term use of nonsteroidal anti-inflammatory medications along with physical therapy may be all the person needs. If the MRI reveals a full-thickness tear or avulsion of the tendon, then surgery to repair the damage may be needed.

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