Bursectomy – Hip

Anesthesia Implications

Position: Supine, Lateral
Time: 1-2 hours (average)
Blood Loss: Moderate (50 – 200 ml)
Post-op Pain: Moderate (3-6)
Maintenance Paralytic: Yes

Approach – It is common to give 1-2mg versed preop. This procedure is typically performed under GETA but spinal anesthesia may also be used. If GETA, paralytic will most likely be required. Where not contraindicated, 1g TXA is typically given at the beginning of the procedure, along with an antibiotic (usually Ancef).

Positioning – Position is performed most commonly in the supine position, but may also be done in the lateral position depending on the surgical technique.

Lateral position (general considerations): If an ETT has been placed, make sure ETT is secure with extra tape.  Unhook anesthesia circuit while turning lateral and be especially careful to keep patient’s head neutral and aligned with body to avoid neck injury. Once lateral, use pillows/blankets/foam headrest to keep the patient’s head in neutral position. The most common nerve injury for orthopedic lateral procedures are neurapraxias of the brachial plexus. These are motor and/or sensory loss for 6-8 weeks due to pressure on the contralateral (dependent) axilla. To prevent this, place an axillary roll under the patient (caudad to the axilla, on the rib cage, and NOT in the axilla). Check routinely to make sure the axillary roll does not migrate into the axilla. If the non-dependent arm is placed on a board, check padding and reposition regularly to avoid radial nerve compression. If a bean bag is employed, check the hard edges to ensure that unnecessary pressure isn’t being put on soft tissues. Pad all dependent bony prominences such as the fibular head (to prevent peroneal nerve injury), and place pillows between the knees and ankles (to prevent saphenous nerve injury). If anterior hip supports are in place, ensure they are properly padded or neuropraxias and/or occlusions of large blood vessels may result.

A hip bursectomy is a procedure performed to remove an inflamed or damaged bursa sac in the hip. The bursa is a small, fluid-filled sac that cushions bones, tendons, and muscles, and reducing and allows for smooth movement. When the bursa becomes inflamed or injured, it can lead to bursitis.

Bursitis causes pain, swelling, and limited mobility. It can result from repetitive movements, trauma, overuse, etc.

The goal of a hip bursectomy is to remove the inflamed or damaged bursa sac, alleviating the symptoms associated with bursitis. By removing the bursa, the friction and pressure in the hip joint can be reduced, leading to pain relief and improved mobility.

The surgeon makes an incision over the affected hip, typically on the side of the thigh over the area of the greater trochanter. The size and location of the incision will vary. The surgeon will locate and dissect the bursa from surrounding tissues, blood vessels, nerves, and tendons.

After the bursa is removed, the incision will be closed with sutures or staples and covered with a padded dressing.