Arthroscopic Bursectomy for Recalcitrant Trochanteric Bursitis

doi:10.1016/j.arthro.2007.02.015

Arthroscopy: The Journal of Arthroscopic & Related Surgery

Volume 23, Issue 8, August 2007, Pages 827-832

https://doi.org/10.1016/j.arthro.2007.02.015 Get rights and content

Purpose: The purpose of this prospective study was to evaluate the arthroscopic treatment of trochanteric bursitis in patients who have not responded to nonoperative treatment. Methods: Thirty patients were enrolled in this study to evaluate the results of arthroscopic bursectomy. Outcomes were assessed by use of a visual analog pain scale, Harris Hip Score, Short Form 36 Health Survey, and additional specific hip function questions. Patients were given the self-administered outcome questionnaires before surgery and at subsequent follow-up visits. Of the patients, 25 were available for a mean follow-up of 26.1 months (range, 13.8 to 41 months). Results: Pain scores on the visual analog scale improved from a preoperative mean of 7.2 (0, no pain; 10, worst pain) to a postoperative mean of 3.1 at final follow-up (P = .0001). Mean Harris Hip Scores improved from a mean of 51 preoperatively to 77 at follow-up (P = .0001). Improvements were also noted in the physical component summary scores of the Short Form 36. The mean physical function score improved from 33.6 preoperatively to 54 at follow-up (P = .022), and in the pain category, the mean score improved from 28.7 to 51.5 (P = .001). One postoperative complication occurred, a seroma that required repeat surgery. One patient had a failed arthroscopic bursectomy and subsequently underwent open bursectomy with resolution of symptoms. Conclusions: Arthroscopic bursectomy appears to be an effective option for recalcitrant trochanteric bursitis and is a viable alternative to open bursectomy. In this prospective study patients had good pain relief and improved function compared with their preoperative status. Improvements in a patient’s status are usually evident by 1 to 3 months after surgery and appear to be lasting. Level of Evidence: Level IV, therapeutic case series.

Section snippets

Study Design

After approval was obtained from our institutional review board, patients were enrolled in the study if they met the inclusion criteria of continued bursal pain and limitation of function (painful abnormal gait, pain with activities of daily living, or inability to lie on the affected side at night) after nonoperative treatment of at least 6 months’ duration. The diagnosis was made from the patient’s history, physical examination, and response to injection. A critical feature in the examination

Results

The mean length of follow-up was 26.1 months (range, 13.8 to 41 months). The visual analog scale scores improved from a preoperative mean of 7.2 to a postoperative mean of 3.1 at final follow-up (0, no pain; 10, worst pain) (P = .0001). Improvements were seen early, at the 1-month examination, and did not tend to deteriorate over time (Fig 4).

Overall, Harris Hip Scores improved from a mean of 51 preoperatively to 77 at final follow-up (P = .0001). Again, early and intermediate data showed

Discussion

When the diagnosis of trochanteric bursitis is made, most patients improve with nonoperative measures. However, when nonoperative interventions fail and the patient’s pain continues, surgical treatment is considered. Historically, this has been done successfully via an open technique.8, 9, 10 Open techniques have included bursectomies, resection and release of the IT band, or even resection of a portion of the greater trochanter.

Recently, endoscopic release of the IT band has been used to treat

Conclusions

Arthroscopic bursectomy appears to be an effective option for recalcitrant trochanteric bursitis in carefully selected patients and is a viable alternative to open bursectomy. In this prospective study patients had good pain relief and improved function compared with their preoperative status. Improvements in a patient’s status are usually evident by 1 to 3 months after surgery and appear to be lasting.

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Le but était de décrire et d’évaluer les bursectomies endoscopiques associées à une ténotomie d’allongement du fascia lata dans les syndromes douleurs du grand trochanter (SDGT) de grade I et II résistantes au traitement médical.
Il s’agit d’une étude rétrospective portant sur 20 patients (7 de grade I, 13 de grade II) revus au recul minimum de 2 ans.
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Hip arthroscopy has recently occupied an important place in the armamentarium of General Orthopedic and especially hip surgeons. It is an effective and innovative procedure with rapidly expanding indications. Advancements in surgical tools and refinement in techniques has revolutionalized modern Hip arthroscopy. Surgeons are now able to address pathology in and around the hip joint that was either misdiagnosed or poorly understood. The procedure allows detailed visualization of acetabular labrum, femoral and acetabular chondral surfaces, fovea, ligamentum teres, synovium and the extra-articular peri-trochanteric space. Minimally invasive surgery is now performed for diagnoses as well as treatment of a variety of Hip disorders. The acceptance and rates of hip arthroscopy are increasing across the board and the associated literature is expanding every day. Increasing surgical experience and improving technology is contributing for more advanced procedures to become popularized, however long-term outcome data about hip arthroscopy is still relatively sparse. We aim to review hip arthroscopy in the light of recent literature and will discuss the current indications, outcomes and complications of the procedure.
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To determine the prevalence of chronic trochanteric bursitis (TB) in patient being treated for femoroacetabular impingement (FAI) and determine the effectiveness of arthroscopic bursectomy and iliotibial band lengthening (AB-ITB-L) at the time of hip arthroscopy for FAI.
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The prevalence of chronic TB with FAI was 7% (90/1,278). Females were 5.3 times more likely to have TB compared with males (95% confidence interval: 3.2-8.7). Patients more than 30 years of age were 2.5 times more likely to have TB (95% confidence interval: 1.48-4.4). Of the 90 patients diagnosed with TB, 72 (54 female, 18 male) with an average age of 36.7 years underwent AB-ITB-L at the time of their index hip arthroscopy for FAI. All 72 patients had associated intra-articular pathology consisting of a combined cam and pincer pathology. The TB (average follow-up = 42 ± 9.9 months) and non-TB group (average follow-up = 42 ± 9.1 months) both had significant improvement from preoperative to postoperative scores for Hip Outcome Score Activities Daily Living, Hip Outcome Score Sport, Modified Harris Hip Score, Western Ontario and McMaster Universities Arthritis Index, Short Form (SF)-12 Physical Component score, and SF-12 Mental Component Score. There was no significant difference between the 2 groups in postoperative patient reported outcome scores.
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: Research was performed at The Hughston Foundation, Columbus, Georgia. The authors report no conflict of interest.

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Original ArticleArthroscopic Bursectomy for Recalcitrant Trochanteric Bursitis

Section snippets

Study Design

Results

Discussion

Conclusions

Arthroscopy

Arthroscopy

Arthroscopy

Trochanteric bursitis: A common clinical problem

Arch Phys Med Rehabil

Trochanteric bursitis and tendinitis

Clin Orthop

The trochanteric syndrome

J Bone Joint Surg Am

Runner’s injuriesPart two. Evaluation and treatment of specific injuries

Am J Sports Med

Evaluation of glucocorticosteroid injection for the treatment of trochanteric bursitis

J Rheumatol

Common regional pain syndromes. II.

Practitioner

Original Article
Arthroscopic Bursectomy for Recalcitrant Trochanteric Bursitis