Is greater trochanteric pain syndrome influenced by pelvic anatomy? A radiological review

Abstract

Introduction: Greater trochanteric pain syndrome (GTPS) is one of the common causes of hip pain, which can be difficult to treat. The incidence of GTPS is highest in the middle aged and the elderly. The iliotibial band (ITB) acts as a tension band over the concave lateral surface of the femur. We postulate that those with wider pelvic morphology have higher tension though the ITB which predisposes to developing GTPS. Aim of the Study: The aim of the study is to evaluate the relationship between pelvic anatomy and GTPS. Methodology: A total of 89 patients underwent steroid injection in a district general hospital for the clinical diagnosis of GTPS between February 2013 and December 2014. We performed a retrospective radiological analysis of their pelvic morphology. We measured intertrochanteric distance and the bispinal distance between both anterosuperior iliac spines on anteroposterior pelvis radiographs. A ratio of intertrochanteric to bispinal distance was calculated. Femoral neck angle and offset were also recorded. Student's t-test was used for statistical analysis. Results: The average intertrochanteric distance and bispinal distance of patients with GTPS and control group were 362 mm and 341 mm, respectively. Intertrochanteric to bi spinal average ratio of 1.06 was found in GTPS group compared to 1.04 in the control group. Patients with GTPS had more varus femoral necks and a larger femoral offset. Intertrochanteric distance, neck-shaft angle, and offset were also statistically significant. Conclusion: We postulate that risk factors for GTPS include female sex, increasing age, and a wider pelvis. To allow for magnification of radiographs, we would suggest the use of the intertrochanteric to bispinal ratio in assessing patients with suspected trochanteric bursitis. We believe a figure of >1.06 would be supportive of the condition.