Top

Archives of Orthopaedic and Trauma Surgery

Published in:

01-11-2016 | Arthroscopy and Sports Medicine

The outcome of endoscopy for recalcitrant greater trochanteric pain syndrome

Authors: James Drummond, Camdon Fary, Phong Tran

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 11/2016

Abstract

Introduction

Greater trochanteric pain syndrome (GTPS), previously referred as trochanteric bursitis, is a debilitating condition characterised by chronic lateral hip pain. The syndrome is thought to relate to gluteal tendinopathy, with most cases responding to non-operative treatment. A number of open and endoscopic surgical techniques targeting the iliotibial band, trochanteric bursa and gluteal tendons have, however, been described for severe recalcitrant cases. We report the outcomes of one such endoscopic approach here.

Materials and methods

We retrospectively reviewed 49 patients (57 operations) who had undergone endoscopic longitudinal vertical iliotibial band release and trochanteric bursectomy. Inclusion criteria included diagnosed GTPS with a minimum of six months of non-operative treatment. Exclusion criteria included concomitant intra- or extra-articular hip pathology and previous hip surgery including total hip arthroplasty. Outcomes were assessed using the Visual Analogue Scale, Oxford hip Score and International Hip Outcome Tool (iHOT-33).

Results

The series included 42 females and 7 males with a mean age of 65.0 years (26.7–88.6). Mean follow-up time was 20.7 months (5.3–41.2). Eight patients had full thickness gluteal tendon tears, of which 7 were repaired. Adjuvant PRP was injected intraoperatively in 38 of 57 operations (67.2 %). At follow-up, overall mean Visual Analogue Scale values had decreased from 7.8 to 2.8 (p < 0.001), Oxford hip Scores had increased from 20.4 to 37.3 (p < 0.001) and iHOT-33 scores had increased from 23.8 to 70.2 (p < 0.001). Of the 57 operations performed, patients reported feeling very satisfied with the surgical outcome in 28 operations (49.1 %), satisfied in 17 operations (29.8 %) and less than satisfied in 12 operations (21.1 %).

Conclusions

While the majority of patients with GTPS will improve with non-operative management, endoscopic iliotibial band release, trochanteric bursectomy and gluteal tendon repair is a safe and effective treatment for severe recalcitrant cases.

Available only for authorised users

Shbeeb MI, Matteson EL (1996) Trochanteric bursitis (greater trochanter pain syndrome). Mayo Clin Proc 71(6):565–569. doi:10.1016/S0025-6196(11)64113-X PubMedCrossRef

Board TN, Hughes SJ, Freemont AJ (2014) Trochanteric bursitis: the last great misnomer. Hip Int 24(6):610–615. doi:10.5301/hipint.5000154 PubMedCrossRef

Silva F, Adams T, Feinstein J, Arroyo RA (2008) Trochanteric bursitis: refuting the myth of inflammation. J Clin Rheumatol 14(2):82–86. doi:10.1097/RHU.0b013e31816b4471 PubMedCrossRef

Lievense A, Bierma-Zeinstra S, Schouten B, Bohnen A, Verhaar J, Koes B (2005) Prognosis of trochanteric pain in primary care. Br J Gen Pract 55(512):199–204PubMedPubMedCentral

Blank E, Owens BD, Burks R, Belmont PJ Jr (2012) Incidence of greater trochanteric pain syndrome in active duty US military servicemembers. Orthopedics 35(7):e1022–e1027. doi:10.3928/01477447-20120621-14 PubMedCrossRef

Segal NA, Felson DT, Torner JC, Zhu Y, Curtis JR, Niu J, Nevitt MC, Multicenter Osteoarthritis Study G (2007) Greater trochanteric pain syndrome: epidemiology and associated factors. Arch Phys Med Rehabil 88(8):988–992. doi:10.1016/j.apmr.2007.04.014 PubMedPubMedCentralCrossRef

Williams BS, Cohen SP (2009) Greater trochanteric pain syndrome: a review of anatomy, diagnosis and treatment. Anesth Analg 108(5):1662–1670. doi:10.1213/ane.0b013e31819d6562 PubMedCrossRef

Fearon AM, Stephens S, Cook JL, Smith PN, Cormick W, Scarvell JM (2012) Are child bearing hips a risk factor for greater trochanteric pain syndrome? J Bodyw Mov Ther 16(2):148CrossRef

Ege Rasmussen KJ, Fano N (1985) Trochanteric bursitis. Treatment by corticosteroid injection. Scand J Rheumatol 14(4):417–420PubMedCrossRef

10.

Brinks A, van Rijn RM, Willemsen SP, Bohnen AM, Verhaar JA, Koes BW, Bierma-Zeinstra SM (2011) Corticosteroid injections for greater trochanteric pain syndrome: a randomized controlled trial in primary care. Ann Family Med 9(3):226–234. doi:10.1370/afm.1232 CrossRef

11.

Foster TE, Puskas BL, Mandelbaum BR, Gerhardt MB, Rodeo SA (2009) Platelet-rich plasma: from basic science to clinical applications. Am J Sports Med 37(11):2259–2272. doi:10.1177/0363546509349921 PubMedCrossRef

12.

Massimi S, LaSalle E, Vongyorachoti J, Lutz GE (2013) Ultrasound-guided platelet rich plasma (PRP) injections for greater trochanteric pain syndrome (GTPS): a retrospective case series. PM&R 5(9):S206–S207CrossRef

13.

Brooker AF Jr (1979) The surgical approach to refractory trochanteric bursitis. Johns Hopkins Med J 145(3):98–100PubMed

14.

Bradley DM, Dillingham MF (1998) Bursoscopy of the trochanteric bursa. Arthroscopy 14(8):884–887PubMedCrossRef

15.

Farr D, Selesnick H, Janecki C, Cordas D (2007) Arthroscopic bursectomy with concomitant iliotibial band release for the treatment of recalcitrant trochanteric bursitis. Arthroscopy 23(8):905. doi:10.1016/j.arthro.2006.10.021 (e901-905) PubMedCrossRef

16.

Zini R, Munegato D, De Benedetto M, Carraro A, Bigoni M (2013) Endoscopic iliotibial band release in snapping hip. Hip Int 23(2):225–232. doi:10.5301/HIP.2013.10878 PubMedCrossRef

17.

Govaert LH, van Dijk CN, Zeegers AV, Albers GH (2012) Endoscopic bursectomy and iliotibial tract release as a treatment for refractory greater trochanteric pain syndrome: a new endoscopic approach with early results. Arthrosc Tech 1(2):e161–e164. doi:10.1016/j.eats.2012.06.001 PubMedPubMedCentralCrossRef

18.

Provencher MT, Hofmeister EP, Muldoon MP (2004) The surgical treatment of external coxa saltans (the snapping hip) by Z-plasty of the iliotibial band. Am J Sports Med 32(2):470–476PubMedCrossRef

19.

Pretell J, Ortega J, Garcia-Rayo R, Resines C (2009) Distal fascia lata lengthening: an alternative surgical technique for recalcitrant trochanteric bursitis. Int Orthop 33(5):1223–1227. doi:10.1007/s00264-009-0727-z PubMedPubMedCentralCrossRef

20.

Baker CL Jr, Massie RV, Hurt WG, Savory CG (2007) Arthroscopic bursectomy for recalcitrant trochanteric bursitis. Arthroscopy 23(8):827–832. doi:10.1016/j.arthro.2007.02.015 PubMedCrossRef

21.

Wiese M, Rubenthaler F, Willburger RE, Fennes S, Haaker R (2004) Early results of endoscopic trochanter bursectomy. Int Orthop 28(4):218–221. doi:10.1007/s00264-004-0569-7 PubMedPubMedCentralCrossRef

22.

Kingzett-Taylor A, Tirman PF, Feller J, McGann W, Prieto V, Wischer T, Cameron JA, Cvitanic O, Genant HK (1999) Tendinosis and tears of gluteus medius and minimus muscles as a cause of hip pain: MR imaging findings. AJR Am J Roentgenol 173(4):1123–1126. doi:10.2214/ajr.173.4.10511191 PubMedCrossRef

23.

Bird PA, Oakley SP, Shnier R, Kirkham BW (2001) Prospective evaluation of magnetic resonance imaging and physical examination findings in patients with greater trochanteric pain syndrome. Arthritis Rheum 44(9):2138–2145. doi:10.1002/1529-0131(200109)44:9<2138:AID-ART367>3.0.CO;2-M PubMedCrossRef

24.

Long SS, Surrey DE, Nazarian LN (2013) Sonography of greater trochanteric pain syndrome and the rarity of primary bursitis. AJR Am J Roentgenol 201(5):1083–1086. doi:10.2214/AJR.12.10038 PubMedCrossRef

25.

Schlesinger N, Dundeva-Baleva P, Abdel-Megid A, Borham A (2013) Trochanteric bursitis: is there ultrasonographic evidence to suggest inflammation? Ann Rheum Dis 71(Suppl 3):275

26.

Anitua E, Andia I, Sanchez M, Azofra J, del Mar Zalduendo M, de la Fuente M, Nurden P, Nurden AT (2005) Autologous preparations rich in growth factors promote proliferation and induce VEGF and HGF production by human tendon cells in culture. J Orthop Res 23(2):281–286. doi:10.1016/j.orthres.2004.08.015 PubMedCrossRef

27.

Tohidnezhad M, Varoga D, Wruck CJ, Brandenburg LO, Seekamp A, Shakibaei M, Sonmez TT, Pufe T, Lippross S (2011) Platelet-released growth factors can accelerate tenocyte proliferation and activate the anti-oxidant response element. Histochem Cell Biol 135(5):453–460. doi:10.1007/s00418-011-0808-0 PubMedCrossRef

28.

Wang X, Qiu Y, Triffitt J, Carr A, Xia Z, Sabokbar A (2012) Proliferation and differentiation of human tenocytes in response to platelet rich plasma: an in vitro and in vivo study. J Orthop Res 30(6):982–990. doi:10.1002/jor.22016 PubMedCrossRef

29.

Schnabel LV, Mohammed HO, Miller BJ, McDermott WG, Jacobson MS, Santangelo KS, Fortier LA (2007) Platelet rich plasma (PRP) enhances anabolic gene expression patterns in flexor digitorum superficialis tendons. J Orthop Res 25(2):230–240. doi:10.1002/jor.20278 PubMedCrossRef

30.

Bunker TD, Esler CN, Leach WJ (1997) Rotator-cuff tear of the hip. J Bone Joint Surg Br 79(4):618–620PubMedCrossRef

31.

Ebert JR, Bucher TA, Ball SV, Janes GC (2015) A review of surgical repair methods and patient outcomes for gluteal tendon tears. Hip Int 25(1):15–23. doi:10.5301/hipint.5000183 PubMedCrossRef

32.

Davies JF, Stiehl JB, Davies JA, Geiger PB (2013) Surgical treatment of hip abductor tendon tears. J Bone Joint Surg Am 95(15):1420–1425. doi:10.2106/JBJS.L.00709 PubMedCrossRef

33.

Domb BG, Botser I, Giordano BD (2013) Outcomes of endoscopic gluteus medius repair with minimum 2-year follow-up. Am J Sports Med 41(5):988–997. doi:10.1177/0363546513481575 PubMedCrossRef

34.

Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW (1988) Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol 15(12):1833–1840PubMed

35.

Dawson J, Fitzpatrick R, Carr A, Murray D (1996) Questionnaire on the perceptions of patients about total hip replacement. J Bone Joint Surg Br 78(2):185–190PubMed

36.

Harris WH (1969) Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am 51(4):737–755PubMed

37.

Lequesne MG, Mery C, Samson M, Gerard P (1987) Indexes of severity for osteoarthritis of the hip and knee. Validation–value in comparison with other assessment tests. Scand J Rheumatol Suppl 65:85–89PubMedCrossRef

Title: The outcome of endoscopy for recalcitrant greater trochanteric pain syndrome
Authors: James Drummond
Camdon Fary
Phong Tran
Publication date: 01-11-2016
Publisher: Springer Berlin Heidelberg
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 11/2016
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-016-2511-z

At a glance: The STEP trials

Springer Medicine

The outcome of endoscopy for recalcitrant greater trochanteric pain syndrome

Abstract

Introduction

Materials and methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction

Materials and methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 11/2016

Reverse polyaxial less invasive stabilization systems for treatment of femoral intertrochanteric fractures of the distal femur

Mobile-bearing TKA improved the anteroposterior joint stability in mid-flexion range comparing to fixed-bearing TKA

The lasso-loop, lasso-mattress and simple-cinch stitch for arthroscopic rotator cuff repair: are there biomechanical differences?

One-year development of QOL following orthopaedic polytrauma: a prospective observational cohort study of 53 patients

Malrotation deformities of the lower extremity and implications on total knee arthroplasty: a narrative review

Biomechanical comparison between the modified rolling-hitch and the modified finger-trap suture techniques