Paper 21: The Outcome of Arthroscopic Treatment of Lateral Trochanteric Pain Syndrome – A Retrospective Review

Abstract

An Outcome Study of 30 consecutive patients with Lateral Trochanteric Pain Syndrome who had not responded to 6 months of conservative treatment, and were then treated with Arthroscopic decompression, bursectomy and Radiofrequency microdebridement. Recalcitrant Lateral Trochanteric Pain Syndrome (LTPS), hip pain caused by trochanteric bursitis, gluteus medius and minimus tendinopathy and or tears, is increasingly being treated arthroscopically. We undertook a retrospective review of 30 consecutive patients (31 hips) with a diagnosis of LTPS with or without gluteus medius and minimus tendinopathy or tears. The study period was from 2003 to 2009 and all patients had a minimum follow up of 6 months. Eligible subjects had a history of at least 6 months conservative treatment, and local anaesthetic and steroid injections into their trochanteric bursa leading to a transient improvement of their symptoms. They were subsequently investigated using clinical examination and ultrasound scan (USS) to confirm a pre operative diagnosis of LTPS (with or without trochanteric bursitis and with abductor tendon pathology). No patient had a preoperative Gluteal tendon tear. Surgery was undertaken in the lateral position and an arthroscopic slit of the Iliotibial Band (ITB), trochanteric bursectomy, and radiofrequency microdebridement of the abductor tendons was performed. Post operatively, all subjects were mobilised, full weight bearing, with no restriction in activity. At their latest review, clinical and USS examinations were performed. We report a mean follow up of 15.1 months, (range 6-46 months). The average age at operation was 56 years (range 19 to 80 years), with a mean body mass index of 26.4 (range 18.9-33.3). There were 22 right and 9 left sided procedures. At their last review, 1 patient had a limp and USS demonstrated a Gluteus medius tear and 9 (29%)patients had a positive Trendelenberg sign and USS demonstrated Gluteal tendon tears in 3. 12 (39%) could perform a single leg stance for 30 seconds pain free, and 19 (61%) had no pain with resisted abduction. Analysis of the Outcome Scores demonstrated that the mean Modified Harris Hip Score (MHSS) improved from 63 to 78 points, and the Non Arthritic Hip Score (NAHS) from 60 to 79 points at final review. Follow up USS demonstrated normal tendons in 4 hips (19%), tendonosis/tendinopathy in 11 (52%), partial thickness tears in 4 (19%), and complete tears in 2 (10%). Arthroscopic ITB decompression with trochanteric bursectomy and radiofrequency microdebridement of the hip abductor tendons is safe and effective in the treatment of refractory lateral hip pain. This intervention should be considered in the management of this difficult condition in selected patients with mild to moderate gluteal tendinopathy