Platelet-Rich Plasma Injections for Refractory Greater Trochanteric Bursitis: A Three-Patient Case Series.

Abstract

Background: Greater trochanteric bursitis is a common cause of lateral hip pain and is frequently considered within the broader clinical spectrum of greater trochanteric pain syndrome. Initial treatment commonly includes activity modification, physical therapy, a home exercise program, nonsteroidal anti-inflammatory drugs, and other nonopioid medications. Corticosteroid injections may provide meaningful relief, although their duration of benefit can be limited. Platelet-rich plasma is an autologous biologic injectate that can be considered as an alternative treatment for greater trochanteric pain syndrome.

Case presentation: We present three patients with clinically diagnosed greater trochanteric bursitis who underwent fluoroscopically guided platelet-rich plasma injections after failing conservative treatment options. The first patient was a woman in her 50s with left greater trochanteric bursitis who had failed physical therapy, a home exercise program, nonsteroidal anti-inflammatory drugs, and muscle relaxants. Two previous corticosteroid injections provided approximately two months and three weeks of relief, respectively. Following a platelet-rich plasma injection into the left greater trochanteric bursa, she reported 50% sustained pain relief at three-month follow-up. The second patient was a woman in her 40s with bilateral greater trochanteric bursitis who had failed physical therapy, a home exercise program, nonsteroidal anti-inflammatory drugs, and duloxetine. A previous corticosteroid injection provided only one week of relief. Following bilateral fluoroscopically guided platelet-rich plasma injections, she reported 70% sustained pain relief at six-week follow-up. The third patient was a man in his 50s with left greater trochanteric bursitis diagnosed clinically and supported by magnetic resonance imaging. He had failed physical therapy, a home exercise program, and nonsteroidal anti-inflammatory drugs and was not interested in corticosteroid injections. An initial platelet-rich plasma injection provided 25% improvement at four-week follow-up. A second injection was performed two weeks later, after which he reported 85% sustained pain relief at three-month follow-up. No complications were reported in any patient.

Conclusion: Fluoroscopically guided platelet-rich plasma injections were associated with clinically meaningful pain improvement in three patients with refractory greater trochanteric bursitis. Two patients experienced moderate improvement after a single treatment, while one patient demonstrated a substantially greater response following a second injection. These cases suggest that platelet-rich plasma may be considered in carefully selected patients who have experienced limited benefit from corticosteroid injections or wish to avoid corticosteroid exposure.