Skip to main content

Advertisement

SpringerLink
Log in

The outcome of endoscopy for recalcitrant greater trochanteric pain syndrome

  • Arthroscopy and Sports Medicine
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Explore related subjects

Discover the latest articles, news and stories from top researchers in related subjects.

References

  1. 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

    Article  CAS  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  3. 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

    Article  PubMed  Google Scholar 

  4. 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):199–204

    PubMed  PubMed Central  Google Scholar 

  5. 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

    Article  PubMed  Google Scholar 

  6. 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

    Article  PubMed  PubMed Central  Google Scholar 

  7. 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

    Article  PubMed  Google Scholar 

  8. 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):148

    Article  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  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

    Article  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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–S207

    Article  Google Scholar 

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

    PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  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)

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  PubMed Central  Google Scholar 

  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):470–476

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  PubMed Central  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  PubMed Central  Google 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

    Article  CAS  PubMed  Google 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

    Article  CAS  PubMed  Google Scholar 

  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

    Article  PubMed  Google 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):275

    Google 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

    Article  CAS  PubMed  Google 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

    Article  CAS  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  Google 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):1833–1840

    CAS  PubMed  Google Scholar 

  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):185–190

    CAS  PubMed  Google Scholar 

  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):737–755

    CAS  PubMed  Google Scholar 

  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 65:85–89

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

Dr. Rachel Zordan for assistance with statistical analysis.

Author information

Authors and Affiliations

  1. Western Health, Melbourne, VIC, Australia

    James Drummond, Camdon Fary & Phong Tran

  2. Department of Orthopaedic Surgery, Western Hospital, Level 1 South, 160 Gordon St, Footscray, VIC, 3011, Australia

    James Drummond, Camdon Fary & Phong Tran

Authors
  1. James Drummond
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Camdon Fary
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Phong Tran
    View author publications

    You can also search for this author in PubMed Google Scholar

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

Below is the link to the electronic supplementary material.

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)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

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

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-016-2511-z

Keywords

Search

Navigation