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The outcome of endoscopy for recalcitrant greater trochanteric pain syndrome

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.

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Acknowledgments

Dr. Rachel Zordan for assistance with statistical analysis.

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Corresponding author

Correspondence to James Drummond.

Ethics declarations

Approval to perform this study was granted by the local ethics committee. All patients provided informed consent to participate in the study.

Funding

This study did not require any funding.

Conflict of interest

The authors declare that they have no conflict of interest.

Electronic supplementary material

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402_2016_2511_MOESM1_ESM.mov

Supplementary material 1 Online Resource 1: Condensed video documenting the patient positioning, surgical approach and sequential steps for the operation performed as part of this study, described in section titled “surgical intervention” (Video is author’s own created in Adobe Final Cut Pro X™ from endoscopic footage taken during surgery) (MOV 29591 kb)

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Drummond, J., Fary, C. & Tran, P. The outcome of endoscopy for recalcitrant greater trochanteric pain syndrome. Arch Orthop Trauma Surg 136, 1547–1554 (2016). https://doi.org/10.1007/s00402-016-2511-z

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Keywords

  • Greater trochanteric pain syndrome
  • GTPS
  • Trochanteric bursitis
  • Endoscopic
  • Bursectomy
  • ITB release