Abstract
Background: There are few prospective studies evaluating the efficacy of various non-operative strategies for treatment of greater trochanter pain syndrome (GTPS). There is a diversity of available interventions and lack of clear consensus for the best modality thus far. Design: Observational prospective cohort study performed during the period of October 2017 and March 2019. Methods: The main objective was to determine if there is a difference in outcome of the Lower Extremity Functional Scale (LEFS) for subjects treated with conservative management (PT), corticosteroid injection (CSI), or percutaneous ultrasonic tenotomy (PUT). Participants were assigned based on physician treatment in a non-randomized manner to PT, a single CSI, or the PUT treatment arm. Subjects participated in outcome assessments at baseline and at 1-, 3-, 6-, and 12-months post intervention. Results: 112 individuals with unilateral GTPS were recruited for this study with 69 PT patients, 31 CSI patients, and 12 PUT patients. The adjusted mean LEFS scores averaged across all time periods remained statistically different between PT, CSI, and PUT (p = 0.0093), indicating significant difference between each treatment arm. PT group saw the greatest improvements from baseline score starting at 1 month and up to 1 year (p = .0004). CSI group did not see significant LEFS improvement until 6 months (p = 0.04) and did not maintain clinically significant improvement by 1 year. PUT group saw significant LEFS improvement at 3 months (p = 0.0001) and maintained clinically significant improvements (≥ 9 LEFS points) throughout the course of the study. Conclusion: PT patients over the study period showed the greatest improvements in LEFS scores compared to CSI and PUT patients. We believe that PT is the best indicated course of treatment for GTPS. PUT may be considered as an additional option if patients have failed other treatment modalities. CSI shows benefit at 6 months, but overall inferior to PT and PUT.
Highlights
Referred to as Greater Trochanteric Pain Syndrome (GTPS), is a common diagnosis with a litany of possible pathologies ranging from hip bursitis, gluteus tendinopathies, external snapping syndrome, and iliotibial band syndrome
Trochanteric bursitis is one of the most common diagnoses given for lateral hip pain, but it has been suggested that lateral hip pain is not usually associated with inflammation of the bursa and gluteus medius insertion
The aim of this study was to determine if there was a difference in outcome using the Lower Extremity Functional Scale (LEFS) for subjects treated with conservative management (PT), corticosteroid injection (CSI), or percutaneous ultrasonic tenotomy (PUT)
Summary
Referred to as Greater Trochanteric Pain Syndrome (GTPS), is a common diagnosis with a litany of possible pathologies ranging from hip bursitis, gluteus tendinopathies, external snapping syndrome, and iliotibial band syndrome. If a gluteus medius or minimus tear is present, people will often present with weakness and pain with active, resisted hip abduction in extension and external rotation while the hip is flexed to 90 degrees Though it is not required for the diagnosis of trochanteric bursitis and tendinopathy, plain radiographs are often obtained to evaluate for enthesopathy, calcifications and an intra-articular source of pain. Given the array of causes for GTPS, there are several modes of treatment intervention They range from conservative management with anti-inflammatory medications, rest, weight loss, and physical therapy, to minimally invasive procedures including corticosteroid injections, percutaneous tenotomy, platelet-rich plasma, to surgical intervention for the most severe cases. There are few prospective studies evaluating the efficacy of various non-operative strategies for treatment of greater trochanter pain syndrome (GTPS). CSI shows benefit at 6 months, but overall inferior to PT and PUT
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