Lateral trochanteric bursa repair improves early hip function after posterior approach total hip arthroplasty: a prospective randomized control trial

Abstract

Background The trochanteric bursa (TB) is an anatomic structure, which is dissected during posterior/lateral hip approaches in Total Hip Arthroplasty (THA). Some surgeons prefer to simply resect the bursa as they believe that it may be responsible for postoperative lateral trochanteric pain (LTP). Others advocate that this tissue acts as a buffer minimizing friction between soft tissue and bone, and therefore its repair may prevent LTP after THA. Aim The purpose of this prospective randomized controlled trial was to compare the clinical results of either resecting or repairing the TB during posterior approach THA. Methods Forty-two patients with primary hip osteoarthritis undergoing THA via a posterior hip approach were randomly assigned to two groups; Group A, or TB resection group and Group B, or TB repair group. All patients in both groups were evaluated postoperatively in terms of hip function, measured by the Harris Hip Score (HHS), at 6 weeks, 3 months, 6 months, and 12 months after surgery, as well as LTP during daily routine activities and lying on the operative side. Results Forty patients completed the study. Postoperative difference in terms of leg length and femoral offset was similar among the two groups (P = 0.467 and P = 0.39, respectively). At 6 weeks, patients in Group B had higher HHS (P = 0.052) and experienced less LTP when lying on the operative side (P = 0.046) but not during activities (P = 0.759). Thereafter, all functional parameters measured had comparable values in both groups. Subgroup analysis failed to identify any correlation between high offset stems and LTP. Conclusion TB repair in posterior approach THA improves hip functional recovery as well as patients’ ability to lie on the operative side during the early postoperative period.

Are There Any Significant Risk Factors Associated with Lateral Trochanteric Pain in Patients Who Have Undergone Primary Hip Replacement?

“…Following THA, LTP is a recognized phenomenon, with reported prevalence ranging from 4% to 17% [ 9 , 10 ]. The etiology of LTP has primarily been attributed to scar tissue formation after surgery and the development of trochanteric bursitis [ 4 ]. However, histological examinations of bursa tissues from patients who underwent THA and were diagnosed with LTP revealed no evidence of acute or chronic inflammation, leading to the inability to confirm this theory [ 11 , 12 ].…”

“…Therefore, it is not entirely accurate to equate the diagnosis of LTP with bursitis and solely attribute the root cause of the problem to it. Chalidis BE et al compared patients who underwent posterolateral intervention and primary THA and those who received bursa repair and resection [ 4 ]. They found an increase in hip movements during the early postoperative period and less pain when patients lay on the side of the surgery in the bursa repair group.…”

“…1 absorbable continuous suture (Vicryl Ethicon). Conversely, in the group that did not undergo bursa repair, only the external rotators were sutured at the adhesion site, and the bursa tissue was excised [ 4 ]. Standardized preoperative and postoperative AP pelvic X-rays were used for radiographic measurements.…”

“…During THA using the posterolateral approach, the trochanteric bursa is often cut or resected before the external rotators are severed at the adhesion site. Some surgeons prefer complete excision of the bursa, believing it may be a contributing factor to postoperative LTP [ 4 ]. Conversely, others argue for the preservation of bursal tissue lateral to the large trochanter, creating a barrier over the trochanter and posterior region to reduce pain by minimizing friction between soft tissues and bone [ 4 ].…”

“…Some surgeons prefer complete excision of the bursa, believing it may be a contributing factor to postoperative LTP [ 4 ]. Conversely, others argue for the preservation of bursal tissue lateral to the large trochanter, creating a barrier over the trochanter and posterior region to reduce pain by minimizing friction between soft tissues and bone [ 4 ]. The primary objectives of this study were twofold: (1) to assess the occurrence of LTP following THA by comparing its incidence between patients who underwent bursa repair and those who did not, and (2) to investigate the associations between trochanteric pain and various factors, including subcutaneous fat thickness, demographic characteristics, comorbidities, as well as radiological and clinical changes.…”