Anesthesiology | Interventional Pain Medicine
Assistant Professor — University of Toronto
Interventional Pain Physician — Afiya Spine & Pain Institute
Staff Anesthesiologist — Scarborough Health Network
Greater trochanteric bursa radiofrequency ablation is a procedure used to reduce pain signals from selected sensory nerves near the outside of the hip.
The name is patient-friendly, but the target is not the bursa itself. The procedure targets small sensory nerves near the back edge of the outside hip bone. Doctors may refer to these as small nerves from the femoral nerve.
Radiofrequency ablation uses heat generated by specialized needles to reduce pain signaling from these small nerves. It does not remove the bursa, repair tendons, release tight tissue along the outside of the thigh, or correct the underlying mechanics that may be contributing to greater trochanteric pain syndrome.
The target is a small group of sensory nerves near the back edge of the outside hip bone.
A study of the nerves around the hip described small nerves from the femoral nerve that may carry pain from this area. The radiofrequency technique used in the linked paper treats the back edge of the outside hip bone, where these small nerves are thought to travel.
This is different from hip joint radiofrequency ablation, which treats nerves around the hip joint itself. Greater trochanteric bursa radiofrequency ablation is aimed at pain on the outside of the hip over the greater trochanter area.
This procedure is most commonly considered for persistent pain on the outside of the hip from greater trochanteric pain syndrome when pain remains significant despite medication, physiotherapy, activity modification, exercise, stretching, walking aids, or steroid injections around the outside hip bursa area.
Greater trochanteric pain syndrome may involve the bursa, the tendons around the outside of the hip, the thick band of tissue along the outside of the thigh, altered walking mechanics, or a combination of these.
Pain is usually felt over the outside of the hip and may be worse with lying on the affected side, walking, stairs, prolonged standing, or pressure over the greater trochanter.
The goal is longer-lasting pain relief so that walking, sleep, physiotherapy, strengthening the muscles on the outside of the hip, walking mechanics, and gradual return to activity are easier.
Patients who may be good candidates include people with pain on the outside of the hip consistent with greater trochanteric pain syndrome who have not had enough relief from conservative treatment and who had meaningful temporary relief from a diagnostic greater trochanteric bursa block.
This procedure may be considered when steroid injections around the outside hip bursa area help only temporarily, when repeated steroid injections are not ideal, or when pain is interfering with physiotherapy and strengthening.
This procedure is not meant for all hip pain. Pain mainly in the groin, deep hip joint pain, nerve pain coming from the lower back, pain near the low back and pelvis joint, and buttock pain may need different assessment and treatment.
Tell us if you have hip replacement surgery booked within the next 6 months. Greater trochanteric bursa radiofrequency ablation itself does not inject steroid into the hip joint, but this information is important if any steroid injection is being considered at the same visit or nearby in time.
Tell us if you already have a hip replacement, have had recent hip surgery, have an active infection, are taking antibiotics, or have had a recent major change in your health.
If you already have a hip replacement and have persistent pain on the outside of the hip, your surgeon should assess the hip replacement before nerve procedures are considered. Problems such as infection, loosening, fracture, instability, or other surgical complications need to be ruled out first.
You usually do not need to fast for this procedure unless you are specifically told otherwise.
The procedure is usually quick, but the full visit includes check-in, assessment, preparation, and recovery.
Most patients should expect the full appointment to take approximately 60 to 90 minutes, although this can vary depending on clinic flow that day.
In simple terms, X-ray guidance is used to find the outside hip bone, and treatment is directed at two small target areas along its back edge.
Most patients describe:
Local anesthetic is used to reduce discomfort. The procedure is usually brief.
You may walk and do normal light activity after the procedure. Avoid unusually strenuous activity for the rest of the day.
Do not drive until any numbness, weakness, heaviness, lightheadedness, or altered sensation has fully resolved.
Do not judge the procedure only by the first few hours afterward. The effect can take time to develop.
Once pain begins to improve, the most important next step is to use that window to participate in physiotherapy, strengthening the muscles on the outside of the hip, walking mechanics, and gradual return to activity as directed.
Some patients notice improvement within 1 to 2 weeks. For others, improvement may take several weeks.
It is common to have temporary soreness or a pain flare before the benefit becomes clear.
The amount and duration of relief varies from person to person. Some patients have substantial relief, some have partial relief, and some do not improve.
Evidence for this procedure is still developing. In the published case series using this technique, all patients reported at least 2 months of relief, and most patients had ongoing relief at follow-up. A practical expectation is several months of benefit when the procedure works, although individual results vary.
The next step depends on how much relief you have after the procedure and how long that relief lasts.
If your pain on the outside of the hip improves significantly, we may continue to monitor your response and focus on physiotherapy, strengthening, walking mechanics, and gradual return to activity.
If your pain returns after a period of meaningful relief, repeat treatment may be considered depending on your response, goals, and overall treatment plan.
If your pain does not improve, or only partially improves, we would usually reassess. This may mean reviewing imaging, reconsidering the pain source, considering whether the pain is coming from the hip joint, lower back, the joint near the low back and pelvis, tendons around the outside of the hip, or another source, or discussing whether orthopedic review is needed.
Keep the needle sites dry for 24 hours. Remove bandages after 24 hours.
If you develop a pain flare, this usually improves with time. Ice packs and over-the-counter pain relievers may help if you are allowed to use them. Avoid unusually strenuous activity for the rest of the day.
Greater trochanteric bursa radiofrequency ablation is generally a low-risk procedure when performed with image guidance and sterile technique, but it is still performed near soft tissues, tendons, small nerves, and blood vessels.
The most common issues are temporary soreness, bruising, lightheadedness, temporary increase in pain, or temporary irritated-nerve discomfort.
Uncommon risks include bleeding, infection, allergic reaction, medication entering a blood vessel, temporary numbness or weakness, skin burn, or worsening pain.
The published case series reported minimal side effects overall, but one patient had a temporary increase in pain after the procedure. As with any newer or less common radiofrequency target, the evidence base is still limited compared with more established procedures.
Seek medical attention if you develop fever, worsening redness or swelling at the needle site, drainage from the needle site, severe worsening pain, or new leg weakness that does not settle.
The procedure itself, including the clinic visit and use of X-ray guidance, is covered by OHIP.
OHIP does not cover the cost of medications used or prescribed, such as local anesthetic, contrast dye, or other medications. These costs may be covered by private insurance.
The medication cost is usually in the range of $25 to $100, depending on the extensiveness of the procedure, but this may vary.
Unless you are told otherwise, you may usually take your regular medications. Blood thinners require separate review.
Tell us before the procedure if you take blood thinners or antiplatelet medications. Do not stop them on your own. We will give you specific instructions based on the medication and your medical history.
Tell us before the procedure if you have ever had an allergy or serious reaction to contrast dye, local anesthetic, or antiseptic skin-cleaning solution.
Tell us if you have diabetes, an active infection, are taking antibiotics, are pregnant or may be pregnant, have hip replacement surgery booked within the next 6 months, or have had a recent major change in your health.
Afiya Spine & Pain Institute
301 - 15 Wellesley St W, Toronto, ON M4Y 1G1
Phone: 416-413-7999 | E-Fax: 416-641-4520
For questions or concerns after your procedure, contact the clinic.