We report the treatment and outcome for 9 patients who developed recalcitrant Greater Trochanteric Pain Syndrome after THA and who did not have any gluteal tendon tear.
Lateral trochanteric pain following total hip arthroplasty has been reported to range between 4-17%.The incidence may vary depending on the approach used and also may be associated with increased lateral offset caused by the arthroplasty. Most patients respond to non-operative measures and cortico-steroid injections, however the treatment of refractory cases has been treated in the past with open bursectomy. Although arthroscopic bursectomy has been shown to be a safe and effective treatment alternative for trochanteric bursitis (also now known as Greater Trochanteric Pain Syndrome, or GTPS), use of this technique has not been reported in patients following total hip arthroplasty(THA).
The study group consisted of 9 patients with GTPS following THA performed through a direct anterior (Hueter) approach, and who had symptoms for greater than 6 months, and had failed conservative treatment. The initial THA had been performed between 2007 and 2010 and in this time a total of 373 THAs had been performed. Follow up was for a minimum of 12 months.
Prior to surgery an Ultrasound examination was performed to exclude gluteal tendon tears.
Arthroscopy was performed in the lateral position, without traction.
The Ilio-Tibial Band (ITB) was split longitudinally and this split then enlarged to an oval shape. Scarred soft tissue overlying the greater trochanter (“bursa”) was excised. The Gluteal tendon attachments were inspected and checked for tears. There were no patients in this group identified as having a tendon tear.
Modified Harris Hip Scores (MHHS) and Non-Arthritic Hip Scores were performed pre-operatively, at 2 weeks, 6 weeks, 6 months and 1 year, and then annually.
MHHS improved from 56.1 to 75.1 and NAHS from 60.5 to 78.1 by one year, and there was continuing improvement in the 3 patients who had been reviewed at 2 years. There were no complications.
Arthroscopic ITB decompression with trochanteric bursectomy is safe and effective in the treatment of refractory GTPS following total hip arthroplasty, and in the absence of gluteal tendon tears.
© 2012 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.