The outcome of endoscopy for recalcitrant greater trochanteric pain syndrome
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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).
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 %).
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.
KeywordsGreater trochanteric pain syndrome GTPS Trochanteric bursitis Endoscopic Bursectomy ITB release
Dr. Rachel Zordan for assistance with statistical analysis.
Compliance with ethical standards
Approval to perform this study was granted by the local ethics committee. All patients provided informed consent to participate in the study.
This study did not require any funding.
Conflict of interest
The authors declare that they have no conflict of interest.
- 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 PubMedPubMedCentralCrossRefGoogle Scholar
- 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 PubMedCrossRefGoogle Scholar
- 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 PubMedCrossRefGoogle Scholar
- 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):275Google Scholar
- 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 PubMedCrossRefGoogle Scholar
- 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 PubMedCrossRefGoogle Scholar
- 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):1833–1840PubMedGoogle Scholar