The outcome of endoscopy for recalcitrant greater trochanteric pain syndrome

Drummond, James; Fary, Camdon; Tran, Phong

doi:10.1007/s00402-016-2511-z

Cited by 27 publications

(39 citation statements)

References 33 publications

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“…Our results show that postoperative satisfaction, pain scores and OHS were significantly worse in cases with previous THA compared to idiopathic cases. With these patients making up 40% of cases in our series, our data add to those presented by Baker et al [14], and are of significance because a consistent and major exclusion factor in studies of outcome following surgery for GTPS is previous ipsilateral THA [13,15].…”

Section: Discussionsupporting

confidence: 79%

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

Robertson-Waters

Berstock

Whitehouse

et al. 2017

International Orthopaedics (SICOT)

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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.

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Section: Discussionsupporting

confidence: 79%

“…Many studies looking at the efficacy of surgical techniques for GTPS exclude patients who have undergone previous THA [15,13]. However, these patients may make up a significant proportion of refractory cases:…”

Section: Introductionmentioning

confidence: 99%

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

Robertson-Waters

Berstock

Whitehouse

et al. 2017

International Orthopaedics (SICOT)

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“…Fox 14 found good or excellent results in 23 of 27 patients undergoing bursectomy with no reported intervention to the iliotibial band. Drummond et al 9 reported improvement on both the Oxford Hip Score and International Hip Outcome Tool (iHOT-33) 20 months after surgery in a retrospective analysis of 49 patients undergoing arthroscopic ITBR and bursectomy, although they included 7 cases that presented full-thickness tendon tears and were repaired, making the comparison between results more complex. Baker et al, 1 in a prospective cohort study of 25 patients, reported an improvement of 26 points on the mHHS at 22 months.…”

Section: Discussionmentioning

confidence: 99%

Radiofrequency Microdebridement as an Adjunct to Arthroscopic Surgical Treatment for Recalcitrant Gluteal Tendinopathy: A Double-Blind, Randomized Controlled Trial

Blakey

O’Donnell

Klaber

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: Recalcitrant greater trochanteric pain is increasingly recognized as an indication for surgical intervention. The arthroscopic approach has become rapidly more common than the open alternative. Hypothesis: Patients undergoing radiofrequency microdebridement (RFMD) as an adjunct to arthroscopic gluteal bursectomy (AGB) and iliotibial band release (ITBR) will experience better functional improvement than AGB and ITBR alone at 1 year. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: A total of 33 patients with failed nonoperative treatment of gluteal tendinopathy were randomly allocated to undergo AGB/ITBR or AGB/ITBR + RFMD. Full-thickness tears were excluded. The primary outcome measure was the modified Harris Hip Score (mHHS) at 52 weeks. Secondary outcome measures included the mHHS, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), visual analog scale (VAS) for pain, and 12-item Short Form Health Survey (SF-12), which were evaluated at 0, 6, 12, 24, and 52 weeks. Statistical significance was defined as P < .05. Results: A total of 33 participants (33 hips; 30 female and 3 male; mean age, 58 years) were randomized; 16 patients underwent AGB/ITBR + RFMD, and 17 underwent AGB/ITBR. Participants’ functionality improved in both groups at all time intervals. The mean mHHS score improved from 57.49 ± 10.61 to 77.76 ± 18.40 ( P = .004) and from 58.98 ± 12.33 to 79.96 ± 18.86 ( P = .001) at 52 weeks in the AGB/ITBR and AGB/ITBR + RFMD groups, respectively, although there was no statistically significant difference between groups. There were no device-related adverse events. Conclusion: AGB/ITBR led to significant improvements in patients with recalcitrant gluteal tendinopathy. In this small RCT, the addition of RFMD showed no additional benefit to AGB/ITBR but provided a safe adjunct for the surgical management of recalcitrant gluteal tendinopathy. Registration: NCT01562366 ( ClinicalTrials.gov identifier).

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“…8 These patients report persistent pain in the lateral hip and may demonstrate weak or painful hip abduction. 10,14,19 Full- and partial-thickness tears of the gluteus medius are increasingly being reported as an underdiagnosed cause of this recalcitrant hip pain. 10,13,14,19 If left untreated, these tears can progressively worsen, cause chronic hip pain and weakness, and affect the gait of the patient.…”

mentioning

confidence: 99%

“…10,14,19 Full- and partial-thickness tears of the gluteus medius are increasingly being reported as an underdiagnosed cause of this recalcitrant hip pain. 10,13,14,19 If left untreated, these tears can progressively worsen, cause chronic hip pain and weakness, and affect the gait of the patient. 9 Patients with gluteus medius tears and 6 months of unsuccessful conservative therapy may be considered candidates for surgical repair.…”

mentioning

confidence: 99%

Endoscopic Gluteus Medius Repair With an ITB-Sparing Versus ITB-Splitting Approach: A Systematic Review and Meta-analysis

Parker

Meyer

Laskovski

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: During hip endoscopy, the iliotibial band (ITB) can be split or preserved to access the peritrochanteric workspace. To our knowledge, no comparative studies have been performed to analyze patient-reported outcomes (PROs) and surgical failure rates (gluteus medius retear and/or revision surgery rates) for ITB-sparing versus ITB-splitting approaches in endoscopic gluteus medius repairs. Purpose: To perform a systematic review and meta-analysis of the literature to evaluate PROs and failure rates of patients undergoing ITB-sparing versus ITB-splitting repairs of the gluteus medius. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review was performed by following PRISMA (Preferred Reporting Items for Systematic Meta-Analyses) guidelines and using the PubMed, Cochrane CENTRAL, and Embase databases. The quality of evidence was evaluated using the modified Coleman Methodology Score. Level 1-4 studies were evaluated for endoscopic abductor repair techniques on all types of gluteus medius tears. Given the small number of studies and varying population sizes, all quantitative data were adjusted for study population size. Results: A total of 13 studies met our inclusion criteria, while more granular data, including ITB approach, were available for 8 studies. Because of the paucity of literature on the subject, all included studies were of lower quality per the modified Coleman Methodology Score. The visual analog scale for pain, the modified Harris Hip Score (mHHS), and the surgical failure rates were compared between approaches. Patients who underwent ITB splitting had a significantly greater change in mHHS (45.5 ± 4.6 vs 27.3 ± 6.5; P < .001) and lower surgical failure rates (3.67 ± 2.33 vs 4.75 ± 2.54; P = .04). There was no significant difference in change in visual analog scale for splitting versus sparing (4.26 ± 0.41 vs 4.39 ± 0.14; P = .96). The results may have been biased by between-group differences, such as patients who undergo ITB sparing being significantly younger. Conclusion: Endoscopic gluteus medius repair is a reliable procedure to improve pain and function in appropriately selected patients. This study highlighted the lack of high-quality literature available regarding ITB approach. However, the evidence to date has suggested that ITB approach may influence hip-specific PROs. Splitting the ITB during abductor repair may be associated with a greater improvement in mHHS and lower surgical failure rates. Further prospective comparative studies are warranted to evaluate the effect of ITB approach.

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The outcome of endoscopy for recalcitrant greater trochanteric pain syndrome

Abstract: 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.

Cited by 27 publications

References 33 publications

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

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

Radiofrequency Microdebridement as an Adjunct to Arthroscopic Surgical Treatment for Recalcitrant Gluteal Tendinopathy: A Double-Blind, Randomized Controlled Trial

Endoscopic Gluteus Medius Repair With an ITB-Sparing Versus ITB-Splitting Approach: A Systematic Review and Meta-analysis

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