Lateral trochanteric pain following total hip arthroplasty: radiographic assessment of altered biomechanics as a potential aetiology

Abdulkarim, Ali; Keegan, Cathy; Bajwa, Raazi; Sheehan, Eoin

doi:10.1007/s11845-017-1701-1

Cited by 14 publications

(11 citation statements)

References 33 publications

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“…Interestingly, our results show that the discrepancy of one single biomechanical parameter such as leg length, femoral or acetabular offset was not different between patients with and without trochanteric symptoms. These results are in accordance with the findings of Abdulkarim et al, who showed no relationship between greater trochanteric pain syndrome and femoral offset or femoral center of rotation 29 . These results suggest, that the restoration of hip anatomics in THA has to be assessed three-dimensionally 17 .…”

Section: Discussionsupporting

confidence: 93%

“…Trochanteric pain syndrome complicates up to 17% of cases after THA 29,30 and has a 5-year post-operative incidence of up to 4.9%, depending on the approach 9 . Although this complication can successfully treated with corticosteroid injections 9,11 , Silva et al showed no evidence of bursitis or inflammation histologically after THA in patients with greater trochanteric pain syndrome 31 .…”

Section: Discussionmentioning

confidence: 99%

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Restoration of leg length and offset correlates with trochanteric pain syndrome in total hip arthroplasty

Worlicek

Messmer

Grifka

et al. 2020

Sci Rep

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persistent pain around the greater trochanter is a common complication after total hip arthroplasty. Restoration of biomechanics such as leg length, femoral und acetabular offset is crucial in THA. The purpose of this study was to evaluate postoperative differences of these parameters after THA and to analyze their association to greater trochanteric pain syndrome. Furthermore, we aimed to evaluate the clinical relevance of trochanteric pain syndrome compared to patient reported outcome measures. 3D-CT scans of 90 patients were analyzed after minimalinvasive total hip arthroplasty and leg length, femoral and acetabular offset differences were measured. Clinical evaluation was performed three years after THA regarding the presence of trochanteric pain syndrome and using outcome measures. Furthermore, the patients' expectation were evaluated. Patients with trochanteric pain syndrome showed a higher absolute discrepancy of combined leg length, femoral and acetabular offset restoration compared to the non-operated contralateral side with 11.8 ± 6.0 mm than patients without symptoms in the trochanteric region with 7.8 ± 5.3 mm (p = 0.01). Patients with an absolute deviation of the combined parameters of more than 5 mm complained more frequently about trochanteric symptoms (29.2%, 19/65) than patients with a biomechanical restoration within 5 mm compared to the non-affected contralateral side (8.0%, 2/25, p = 0.03). Clinical outcome measured three years after THA was significantly lower in patients with trochanteric symptoms than without trochanteric pain (p < 0.03). Similarly, fulfillment of patient expectations as measured by THR-Survey was lower in the patients with trochanteric pain (p < 0.005). An exact combined restoration of leg length, acetabular and femoral offset reduces significantly postoperative trochanteric pain syndrome and improves the clinical outcome of the patients.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Restoration of leg length and offset correlates with trochanteric pain syndrome in total hip arthroplasty

Worlicek

Messmer

Grifka

et al. 2020

Sci Rep

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“…This means that exceeding offset increase can both increase gluteus tension and hip stability, but, on the other hand, could worsen knee function. It is believed that lateral trochanteric pain may be the consequence of increased offset, but Abdulkarim et al [26] found in their retrospective controlled case series that lateral trochanteric pain is not associated with implant positioning or increased offset.…”

Section: Discussionmentioning

confidence: 99%

Restoring global offset and lower limb length with a 3 offset option double-tapered stem

Biggi

Banci²,

Tedino

et al. 2020

BMC Musculoskelet Disord

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Background A proper restoration of hip biomechanics is fundamental to achieve satisfactory outcomes after total hip arthroplasty (THA). A global hip offset (GO) postoperatively reduction of more than 5 mm was known to impair hip functionality after THA. This study aimed to verify the restoration of the GO radiographic parameter after primary THA by the use of a cementless femoral stem available in three different offset options without length changing. Methods From a consecutive series of 201 patients (201 hips) underwent primary cementless THA in our center with a minimum 3-year follow up, 80 patients (80 hips) were available for complete radiographic evaluation for GO and limb length (LL) and clinical evaluation with Harris hip score (HHS). All patients received the same femoral stem with three different offset options (option A with – 5 mm offset, option B and option C with + 5 mm offset, constant for each sizes) without changing stem length. Results Mean GO significantly increased by + 3 mm (P < 0.05) and mean LL significantly decreased by + 5 mm (P < 0.05) after surgery, meaning that postoperatively the limb length of the operated side increased by + 5 mm. HHS significantly improved from 56.3 points preoperatively to 95.8 postoperatively (P < 0.001). Offset option A was used in 1 hip (1%), B in 59 hips (74%) and C in 20 hips (25%). Conclusions The femur is lateralized with a mean of + 5 mm after surgery than, the native anatomy, whatever type of stem was used. Thus, the use of this 3-offset options femoral stem is effective in restoring the native biomechanical hip parameters as GO, even if 2 offset options were considered sufficient to restore GO.

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“…The etiology of LTP has been largely attributed to postsurgical scar tissue formation and development of trochanteric bursitis [ 11 ]. However, this theory has not been confirmed by histological studies, which failed to reveal any acute or chronic inflammation of the examined bursae from patients suffering from trochanteric pain in the setting of THA [ 12 – 14 ]. So, the term bursitis may not accurately describe the origin and characteristics of the symptoms, in such cases.…”

Section: Discussionmentioning

confidence: 99%

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

Chalidis¹,

Sachinis²,

Hawdon³

et al. 2022

Arthroplasty

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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.

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Lateral trochanteric pain following total hip arthroplasty: radiographic assessment of altered biomechanics as a potential aetiology

Cited by 14 publications

References 33 publications

Restoration of leg length and offset correlates with trochanteric pain syndrome in total hip arthroplasty

Restoration of leg length and offset correlates with trochanteric pain syndrome in total hip arthroplasty

Restoring global offset and lower limb length with a 3 offset option double-tapered stem

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

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