Z-lengthening of the iliotibial band to treat recalcitrant cases of trochanteric bursitis

Abstract

Greater trochanteric bursitis is a relatively common presentation at hip clinics. It presents with pain around the greater trochanter. Diagnosis is usually made on clinical grounds when other hip and spinal pathologies are ruled out and there is tenderness present over the trochanteric region. Rheumatoid arthritis (1), athletic injury (2), total hip arthroplasty (3) and idiopathic disease (4) are some of the known causes of trochanteric bursitis. Treatment is mainly non-operative and expectant; however various operative interventions have been described in the literature. We present a series of 16 patients who had recalcitrant trochanteric bursitis following failed non-operative treatment and were treated with bursectomy and Z-lengthening of the iliotibial band. All 14 patients who answered the questionnaire were happy with the outcome of operation and 13/14 patients would undergo a similar procedure again. To the best of our knowledge, this is the only series in the literature describing this particular procedure for treatment of trochanteric bursitis.

The effect of iliotibial band surgery at the hip: a systematic review

“…Specifically, we excluded studies [ 2 , 23 , 61 , 66 ] which, after full text review, did not fulfill our inclusion criteria. We also excluded potential eligible studies [ 7 , 9 , 17 , 29 , 45 , 54 , 55 , 69 ] in which individuals with age < 18 years, or previous hip surgery, could not be separated in the study population after attempted contact with the authors.…”

“…The review examined general surgical management of GTPS and included studies with gluteal tears ( n = 8). Baker et al [ 2 ] and Govaert et al [ 17 ] were excluded from our review as stated above, and also Chirputkur et al [ 9 ] who included a THA patient, Larose et al [ 28 ] with only abstract available, and Wiese et al [ 63 ] with a pediatric population. Reid et al [ 51 ] found that ITB lengthening techniques varied between studies, that studies had poor methodological quality and were predominantly single surgeon retrospective case series.…”

“…The eight of 49 patients who had a gluteal repair was an additional perioperative ad-on and not intended treatment [ 13 ]. The authors of the remaining six excluded studies did not respond [ 7 , 9 , 17 , 45 , 54 , 55 , 69 ].…”

The painful primary hip replacement – review of the literature

“…Response rate is slightly less than in non-prosthetic trochanteric bursitis (80% vs 90.3%) [61]. In a few recalcitrant cases open or arthroscopic bursectomy and Z-lengthening of the iliotibial band may be indicated [62,63]. In cases of tendon tear with relevant functional impairment found at the time of primary THR or postoperatively, repair has to be performed before fatty degeneration of the abductors [64,65].…”