Surgery for greater trochanteric pain syndrome after total hip replacement confers a poor outcome

Abstract

Purpose Surgery for greater trochanteric pain syndrome (GTPS) may be indicated for cases refractory to conservative measures. We aim to evaluate patient reported outcomes and adverse events following surgery. Methods Postal questionnaires were used to evaluate a consecutive series of 61 bursectomy and gluteal fascia transposition (GFT) procedures. Study outcomes were Oxford hip score, satisfaction score, visual analogue score, pain lying on the affected side, and the duration of pain relief after surgery. Results We received responses regarding 52 procedures at a median of 34 months follow-up; 40% of cases of GTPS occurred following THA. We observed a bimodal distribution of satisfaction scores. The early post-operative complication rate was 13%; an additional seven cases (12%) required further surgery at a later date. Idiopathic GTPS had significantly better post-operative satisfaction than GTPS following THA, 87.5 vs. 37.5 (p = 0.006); Oxford hip scores, 35 vs. 15 (p = 0.015); and visual analogue scores, 20 vs. 73 (p = 0.005). Conclusion We observed overall poor outcomes, significant complications and concerning reoperation rates. Cases with previous joint replacement were associated with the worst outcomes.

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

“…In addition, the results of Robertson-Watres et al showed a poor outcome for patients with surgical treatment for greater trochanteric pain syndrome after THA, analyzing patient satisfaction score; 10 cm visual analogue score referring to current level of pain (0-100, 0 representing no pain); Oxford hip score; Likert scale duration of pain relief following the operation; Binary presence of pain when lying on affected side 8 . This confirms the importance of accurate three-dimensional restoration of the hip joint biomechanics and shows the necessity to prevent this complication already during the initial surgery.…”

“…In addition MRI analysis show peritrochanteric lesion in over 30% [4][5][6] . Following total hip arthroplasty (THA) 4-17% of patients report these symptoms according to previous studies [7][8][9][10][11] . The reasons of trochanteric pain syndrome as reported in previous studies are manifold and include tendinopathy or microtrauma of the gluteus medius and minimus tendons, often without signs of inflammation 12,13 .…”

Greater trochanteric pain syndrome: Evaluation and management of a wide spectrum of pathology

“…In patients with GTPS after total hip arthroplasty, however, outcomes following bursectomy are significantly less favorable than in patients with idiopathic GTPS. 66 , 67 Robertson-Waters et al 66 found that only 18% of patients experienced sustained pain relief at median 34-month follow-up and 22% experienced no improvement at all. The authors reported a reoperation rate of 11% and a complication rate of 13%, including one patient who developed a postoperative wound infection that progressed to a periprosthetic joint infection.…”

Trochanteric spurs and surface irregularities on plain radiography are not predictive of greater trochanteric pain syndrome

“…These 56 patients have been reported in a previous study that evaluated patient-reported outcomes following trochanteric bursectomy and transposition of the gluteal fascia. 9 The patients in this previous study were diagnosed with GTPS based on clinical history and greater trochanteric tenderness. They all underwent surgery when symptoms had persisted for over 12 months and a transient response to conservative measures, including corticosteroid injection and physiotherapy, was observed.…”