Trochanteric Bursitis Following Primary Total Hip Arthroplasty: Incidence, Predictors, and Treatment

Shemesh, Shai; Moucha, Calin S.; Keswani, Aakash; Maher, Nolan A.; Chen, Darwin; Bronson, Michael J.

doi:10.1016/j.arth.2017.11.016

Cited by 21 publications

(8 citation statements)

References 24 publications

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“…While it is important to consider that this is based on surgeon estimates and not real data, it is still interesting to compare these estimates across approaches. Although a lack of notable difference among the various approaches is consistent with previous clinical literature, 16 lower rates of GTPS are sometimes touted as a potential benefit of certain approaches. Among the myriad of potential causes of GTPS, gluteus medius/minimus tears (i.e., "bald trochanter" syndrome 20 ) can occur with any surgical approach either because the insertion is not visualized or because it fails to heal after intraoperative repair.…”

Section: Figuresupporting

confidence: 69%

“…The estimated proportion of GTPS seen in our survey (8%) is in line with the best available evidence (3 to 17%). 1,16 Using the results of our survey, this would suggest that nearly 5,000 patients are affected by post-THA GTPS each year and nearly 1,500 patients per year receive and subsequently fail first-line therapy for post-THA GTPS in Canada alone. Given the absence of standardized diagnostic guidelines, this may be an under-representation of total burden because of underdiagnosis.…”

Section: Figurementioning

confidence: 98%

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Management of Greater Trochanteric Pain Syndrome After Total Hip Arthroplasty: Practice Patterns and Surgeon Attitudes

Axelrod,

Ekhtiari,

Winemaker

et al. 2023

JAAOS Glob Res Rev

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Introduction: Greater trochanteric pain syndrome (GTPS) or trochanteric bursitis is described as pain on the lateral side of the hip that does not involve the hip joint and can be elicited clinically by palpation over the greater trochanter. To date, there remains no consensus on clinical guidelines for either diagnosis or management of GTPS. Methods: To understand the practice patterns, beliefs, and attitudes relating to the management of GTPS after total hip arthroplasty, a survey was developed and completed by Canadian arthroplasty surgeons. The final survey consisted of 23 questions divided into three sections: 1) screening questions; 2) demographic information; and 3) practice patterns, attitudes, and beliefs. Results: Most surgeons use physical examination alone for diagnosis. A detailed analysis indicates that surgeons primarily treat GTPS with oral anti-inflammatories (57.1%), structured physiotherapy (52.4%), and steroid injections (45.2%). Management options are typically nonsurgical and comprise a combination of either unstructured or targeted physiotherapy, corticosteroid injections, or platelet-rich plasma. Discussion: There remains an absence of clinical consensus for the diagnosis and management of GTPS after total hip arthroplasty. Physical examination is most often relied on, regardless of the availability of imaging aids. While common treatments of GTPS were identified, up to one-third of patients fail initial therapy.

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Section: Figuresupporting

confidence: 69%

Section: Figurementioning

confidence: 98%

Management of Greater Trochanteric Pain Syndrome After Total Hip Arthroplasty: Practice Patterns and Surgeon Attitudes

Axelrod,

Ekhtiari,

Winemaker

et al. 2023

JAAOS Glob Res Rev

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“…5 It is possible that lateral hip pain following THA is due to trochanteric bursitis, although to formally diagnose trochanteric bursitis there would need to be a full clinical evaluation with specific criteria and potentially lateral hip imaging. 2 This study focused on evaluating patients who developed lateral hip pain following THA postoperatively between the years of 2014-17. Any other cause of lateral hip pain was excluded such as osteolysis, trochanteric insufficiency or nonunion, infection, and abductor insufficiency or weakness.…”

Section: Discussionmentioning

confidence: 99%

“…While THA is generally well tolerated, when there are postoperative complications persistent lateral hip pain is one of the most common with an incidence of between 3% and 17% of THAs. 2 One of the potential causes of lateral hip pain following total hip arthroplasty is inflammation of the trochanteric bursa resulting in palpable pain over the greater trochanter. 3 Femoral offset is a key factor that determines the stability of the postoperative hip.…”

Section: Introductionmentioning

confidence: 99%

Changes in femoral offset is not associated with increased incidence of lateral hip pain following total hip arthroplasty

Foy

Kielminski

Cavazos

et al. 2021

Journal of Clinical Orthopaedics and Trauma

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Increased femoral offset following total hip arthroplasty allows for greater stability of the hip joint. However, the increase in femoral offset can cause an impingement of local structures resulting in persistent lateral hip pain. There is conflicting evidence whether changes in femoral offset increases the rates of lateral hip pain following total hip arthroplasty. Methods: This was a retrospective case control study that grouped patients based on the presence of persistent lateral hip pain following total hip arthroplasty. Patients were then stratified according to their change in femoral offset (<-5 mm, -5 mm < x < 5 mm, and 5 mm<). A chi squared analysis was then performed to see if there was a statistical difference in the rates of lateral hip pain amongst these groups. Results: A change in femoral offset of the implanted hip relative to the native hip was not associated with increased rates of lateral hip pain following total hip arthroplasty (p ¼ 0.35). A change in femoral offset of the implanted hip relative to the contralateral hip was not associated with increased rates of lateral hip pain following total hip arthroplasty (p ¼ 0.40). Conclusion:This study found that there was no association between increased femoral offset and rates of postoperative lateral hip pain following total hip arthroplasty. Future investigations should look at a larger sample size with multiple institutions to further assess the impact on femoral offset changes on rates of persistent lateral hip pain.

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“…This can be a result of irritation due to over use, change in posture, leg length discrepancy or inappropriate offset. This is usually treated non operatively with simple analgesia, non-steroidal anti-inflammatory drugs or steroid injections [124].…”

Section: Other Complicationsmentioning

confidence: 99%

Complications of Total Hip Replacement

Park¹,

Merchant²

2018

Total Hip Replacement - An Overview

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Total hip replacement is a highly effective surgical procedure for patients suffering from end stage osteoarthritis and its success in improving symptoms of osteoarthritis has meant that its use has increased across many healthcare systems. Although in experienced hands the procedure provides very effective outcomes one must be aware of the potential complications of the procedure. These can be divided into general and procedure specific. General complications include infections, postoperative pulmonary issues and thromboembolic complications. Procedural specific complications include a surgical site infection, haemorrhage, nerve injury, dislocation, leg length discrepancy, periprosthetic fractures and heterotrophic ossification. This chapter explores and describes the complications a surgeon may face when performing a total hip replacement and how one may avoid and address these.

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Trochanteric Bursitis Following Primary Total Hip Arthroplasty: Incidence, Predictors, and Treatment

Cited by 21 publications

References 24 publications

Management of Greater Trochanteric Pain Syndrome After Total Hip Arthroplasty: Practice Patterns and Surgeon Attitudes

Management of Greater Trochanteric Pain Syndrome After Total Hip Arthroplasty: Practice Patterns and Surgeon Attitudes

Changes in femoral offset is not associated with increased incidence of lateral hip pain following total hip arthroplasty

Complications of Total Hip Replacement

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