Paper #40 - ISHA Annual Scientific Meeting 2016
Outcomes of Arthroscopic Management of Trochanteric Bursitis in Patients with Femoroacetabular Impingement: A Matched Cohort Study
Alexander R. Vap, MD, Vail, CO UNITED STATES
Justin J. Mitchell, MD, Vail, CO UNITED STATES
Karen K. Briggs, MPH, Vail, CO UNITED STATES
Marc J. Philippon, MD, Vail, CO UNITED STATES
Steadman Philippon Research Institute , Vail, CO, UNITED STATES
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 a common problem seen by orthopaedic surgeons, affecting as many as 5.6 patients per 1000 adults. 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 Iimpingement (FAI). Trochanteric bursitis is typically self-limiting and responsive to conservative treatment in the majority of patients; however, in those with chronic pain following failed nonoperative treatment, surgical intervention may be necessary.
Purpose: The purpose of this study was to establish the prevalence of of patients with FAI who develop recalcitrant TB, and 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. Further, this study aims to compare patient outcomes in a match-controlled study to patients with isolated primary FAI who underwent hip arthroscopy without AB-ITB-L. It was hypothesized that outcome scores for the recalcitrant TB cohort who underwent hip arthroscopy for primary FAI would be equivalent to the control group.
Methods: A retrospective review of prospectively collected data was completed on patients diagnosed with primary FAI (CAM,Pincer type, or Mixed type) and recalcitrant TB. Physical examination findings in all patients included positive Ober test, Faber test, and tenderness to palpation over the greater trochanter (TTP GT). 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 an arthroscopic or open hip surgery was also excluded. Patients were then matched by age and gender to patients without recalcitrant TB.
Results: Prevalence of recalcitrant TB with FAI between 2008 and 2013 was 7% (90/1278). Females were 5.3 times more likely to be suffering from 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 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 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 (a<), center edge angle (CEA), joint space (lateral, 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, modified Harris hip score, WOMAC, SF-12 physical component score, and SF-12 mental component score. There was no significant difference between the two cohorts.
Conclusion: The prevalence of recalcitrant TB in the FAI population was 7%, and was more 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.
Level of Evidence: Matched Cohort Study, Level III