FDA Status: Not Applicable
Summary: Patients who undergo concomitant arthroscopic treatment for recalcitrant trochanteric bursitis report excellent pain relief, and have equivalent results and outcome scores to those patients with primary FAI without recalcitrant bursitis.
Background: Trochanteric bursitis (TB) is an irritation and inflammation of the bursa that lies deep to the iliotibial band, just superficial to the gluteus medius at the lateral aspect of the proximal thigh. Patients with this condition often present with debilitating lateral hip pain. While the exact etiology is unknown, it is frequently seen in association with pelvic girdle conditions such as femoral-acetabular Impingement (FAI). Trochanteric bursitis is typically self-limiting in the majority of patients, however, in those with chronic pain following failed nonoperative treatment, surgical intervention may be necessary.
Purpose/Hypothesis: To establish the prevalence of and clinical profile of patients with FAI who develop recalcitrant TB. To evaluate the effectiveness of arthroscopic bursectomy and ITB lengthening (AB-ITB-L) at the time of index hip arthroscopy for patients with recalcitrant TB and FAI and compare those patient outcomes in a match-controlled study to patients with isolated primary FAI who undergoes hip arthroscopy without AB-ITB-L. It was hypothesized that outcome scores for the recalcitrant TB cohort will be equivalent to the control group of primary FAI without TB who underwent hip arthroscopy.
Study Design: Matched Cohort Study, Level III
Methods: A retrospective review of prospectively collected data was completed on patients diagnosed with primary femoroacetabular impingement (CAM, Pincer type, or Mixed type) and recalcitrant trochanteric bursitis. Physical examination findings in all patients included positive Ober test, Faber test, and tenderness to palpation over the greater trochanter. Patients were included if they underwent hip arthroscopy with labral repair and femoral and/or acetabular osteoplasty and AB-ITB-L. Patients were excluded if they were diagnosed with gluteus medius or minimus tears, spinal stenosis, spondylosis or radiculopathy. Any patient that had previously undergone hip surgery arthroscopic or open was also excluded. Included patients were matched to patients who met the same inclusion/exclusion criteria with exception of no diagnosis and treatment of recalcitrant TB.
Results: Prevalence of TB with FAI between 2008 and 2013 was 7%(90/1278). Females were 5.3 times more likely to have TB compared to males [95%CI: 3.2 to 8.7]. Patients over 30 years of age were 2.5 times more likely to have TB [95% CI: 1.48 to 4.4]. Of the 90 patients 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 and had minimum 2 year follow-up. All 72 patients had associated intraarticular pathology consisting of a combined cam and pincer pathology. There was no significant difference in preoperative alpha angle, CEA, joint space (latera, anterior, foveal), or range of motion (Flexion, Abduction, Adduction, Internal Rotation, External Rotation) between the TB and the non-TB group. The TB (average follow up = 42 months +/- 9.9) and non-TB group (average follow up = 42 =/-9.1) both had significant improvement from preoperative to postoperative scores for HOS ADL, HOS Sport, MHHS, WOMAC, and SF12 (PCS & MCS) (Table 1). There was no significant difference in the outcome scores when comparing the two cohorts.
Conclusion: The prevalence of recalcitrant TB in the FAI population is not insignificant and it is commonly seen in females greater than 30 years old. Patients who undergo concomitant AB-ITB-L for recalcitrant TB report excellent pain relief, and have equivalent results and outcome scores to those patients with primary FAI without recalcitrant TB. It is recommended that arthroscopic hip surgeons perform an arthroscopic bursectomy and ITB lengthening at the time of the index procedure for the patient’s FAI if they are diagnosed with recalcitrant TB.