Outcomes of Endoscopic Treatment for Greater Trochanteric Pain Syndrome: Minimum of Two-Year Follow-Up

Abstract

Objectives:Greater trochanteric pain syndrome (GTPS) is a common complaint with an estimated incidence of 1.8/1,000 persons. GTPS usually responds well to conservative treatment. In refractory cases, endoscopy offers a less invasive approach than open surgery, and offers the advantage of evaluating and treating coexistent intraarticular disorders. The purpose of this study is to report the clinical outcomes of endoscopic treatment for GTPS at a minimum of two years follow-up and to report the incidence and outcomes of hip abductor tears.Methods:During the study period, patients who presented with lateral hip pain, pain on palpation over the greater trochanter or hip abductor weakness and were treated with an endoscopic trochanteric bursectomy were included. Exclusion criteria were previous hip conditions and Tonnis grade ≥ 2. Patient reported outcome (PRO) scores used include the modified Harris Hip Score (mHHS), the Non-Arthritic Hip Score (NAHS), the Hip Outcome Score-Activities of Daily Living (HOS-ADL), and the Hip Outcome Score-Sport Specific Subscale (HOS-SSS). PRO scores were collected pre-operatively and two-years postoperatively. Visual analog scale (VAS) scores and patient satisfaction ratings were also collected. Any revision surgeries, complications, or conversions to total hip arthroplasty (THA) were noted.Results:A total of 59 cases met the inclusion/exclusion criteria, of which 50 patients (85%) were available for follow-up at minimum two years. Forty-six patients reported two-year follow up PRO scores and four patients needed total hip replacement surgery. All patients had endoscopic trochanteric bursectomy. Thirteen patients (26%) had a gluteus medius tear treated during surgery. Average follow up was 31 months (range 24-50). Average age was 50 years (range 23-75). Patients demonstrated significant improvement (p<0.01) from pre-operative to last follow-up in all PROs. Patients who underwent gluteus medius (GM) repair demonstrated higher improvement in all PROs compared to patients without GM pathology (Table 1). Four patients (8%) went on to have THA, three patients (6%) required revision arthroscopy. Nine patients (18%) had a complication; however, all were transient and none required further surgical intervention.Conclusion:Patients experienced a statistically significant clinical improvement in PROs, and pain scores, and reported high satisfaction after endoscopic trochanteric bursectomy with or without gluteus medius repair. We conclude that peritrochanteric endoscopy is a safe and efficient treatment option for recalcitrant GTPS.