Greater Trochanteric Pain Research Articles

Offset Considerations in Total Hip Arthroplasty.

To perform total hip arthroplasty (THA) successfully, a surgeon must be able to place the implants in a position that will restore and duplicate the patient's baseline anatomy and soft-tissue tension. One of the critical factors is the restoration of femoral offset. It is the goal of this review to precisely define measurement of offset in THA, describe its role in hip joint biomechanics, outline alterations that can be performed intraoperatively, and explain how it can create potential pathologic states. If there is a lack of offset restoration, it can result in a host of complications, including bony impingement with pain, edge loading or prosthetic joint instability, and alterations in the muscle length-tension relationship leading to reduced motor performance. Excessive femoral offset can increase hip abductor muscle and iliotibial band tension resulting in greater trochanteric pain regardless of the surgical approach. The purpose of this review was to analyze intraoperative surgical factors, choice of prosthetic implant type and position that are required to maximize stability, and dynamic motor performance after THA.

PENG for chronic pain: the clinical effectiveness of pericapsular nerve group block in chronic hip pain.

To evaluate the efficiency and tolerability of pericapsular nerve group block (PENG) for the treatment of chronic hip pain. This is a retrospective, single-centre, 4-group study conducted over a 3-month period to find out the most typical cause of chronic hip pain. A total of 112 patients with symptomatic hip osteoarthritis (OA), Stage 2-3, greater trochanteric pain (GTPS) and chronic pain after total hip arthroplasty (cTHA), who had an ultrasound-guided PENG block, were selected. To assess the effectiveness of the treatment, the Western Ontario and McMaster Universities osteoarthritis index (WOMAC) and visual analogue scale (VAS) scores of the patients prior to treatment were compared with their scores after the 1st week, 1st month, and 3rd month of treatment. The study also aimed to analyse the patients' initial feelings of alleviation following the block (1st VAS/2) and problems experienced both during and after the block. The parameters studied included pain, stiffness, and results of physical activity in the 1st week, 1st month, and 3rd month following PENG block application. At the beginning of the 1st week, of the 112 patients who were administered a PENG block for hip pain, we reported a 62% improvement in pain, a 52% reduction in stiffness, and a 53% increase in physical activity. Even though these results slightly declined in the 1st and 3rd months, the rates were still higher than 45%. Overall, the PENG block was well-tolerated by the patients in our study. No treatment-related infections or any other serious complications were observed.

Motor control exercises versus general exercises for greater trochanteric pain syndrome: A protocol of a randomized controlled trial

Greater trochanteric pain syndrome is an overarching term used to define pain and tenderness in the greater trochanteric region of the femur, which is more common in women. Abnormal control of lower limb movements and deficient neuromuscular parameters may lead to greater trochanteric pain syndrome; however, no studies have used neuromuscular training as a treatment strategy. Thus, this study aims to compare the effect of a protocol of general exercises versus a program of motor control training on pain at baseline and after treatment in women with greater trochanteric pain syndrome. The study was approved by the Research Ethics Committee (CAAE: 87372318.1.0000.5406) and has been prospectively registered on the Brazilian Registry of Clinical Trials (RBR-37gw2x). Sixty participants will be randomized to receive motor control exercises or general exercises. The application will be performed twice a week for 8 weeks. The participants will be evaluated before the treatment (T0), after 8 weeks of intervention (T8) and after 60 weeks of intervention (T60). The primary outcome measures will be the hip pain intensity, and secondary outcomes will be muscle strength, kinesiophobia, global perceived effect, pain catastrophization, central sensitization and quality of life. Studies have suggested that greater trochanteric pain syndrome may be related to poor hip and pelvic control, however, no study has investigated an exercise protocol focused on increasing the strength of the abductor and extensor muscles of the hip associated with pelvic control training, especially in positions of unilateral support, such as gait. This study will help determine whether greater trochanteric pain syndrome is related to abnormal control of lower limb movements.

Endoscopic fascia lata release for treatment of gluteal tendinopathy: a prospective study with a follow-up of 6 months to 1 year.

Greater trochanteric pain syndrome (GTPS) is clinically defined as greater trochanter pain with mechanical characteristics. The most common diagnosis is gluteal tendinopathy. Most cases of gluteal tendinopathy resolve with conservative management. In case of refractory pain endoscopic surgical treatment can resolved symptoms. This article presents a prospective study of endoscopic proximal fascia lata release associated to trochanteric bursectomy for recalcitrant trochanteric pain syndrome. 33 patients (35 hips) with refractory pain during more than six months were included. All patients were treated by endoscopic iliotibial band release and bursectomy according to Ilizaliturri. Outcomes were assessed by using Harris hip score and Womac hip score. Patients were follow-up until one year after surgery. The mean age was 53.7 years old, there was 9 men and 24 women. There were two bilateral cases in the female group. The average duration of conservative treatment was 20 months (CI95 9 to 31 months). 68% of patients were satisfied of the surgery with disappearance of pain after surgery. WOMAC and Harris hip score significantly improved after surgery until 6 months (respectively from 67 to 29 and from 40 to 76 - p<0.05). No complication was reported. Age, body mass index and duration of conservative treatment did not influence surgical results. This study showed that the endoscopic ilio tibial band (ITB) release and trochanteric bursectomy is simple, safe and easily reproductible but future prospective studies with a larger number of patients are required.

An indirect evaluation between corticosteroid injections and gluteal exercises in the management of pain in greater trochanteric pain syndrome

An indirect evaluation between corticosteroid injections and gluteal exercises in the management of pain in greater trochanteric pain syndrome

Greater Trochanteric Pain Syndrome (GTPS): A clinical prospective study of treatment options

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.

The natural history of greater trochanteric pain syndrome: an 11-year follow-up study

BackgroundGreater trochanteric pain syndrome (GTPS) is a musculoskeletal condition which can cause disability and reduce quality of life. However, limited evidence is available on the long-term outcomes of people with GTPS. Our aims were to determine the long-term prevalence of GTPS; to calculate the proportion of people with GTPS who had developed hip osteoarthritis (OA); and to determine the level of function and quality of life, 11-years after initial GTPS diagnosis.MethodsA prospective 11-year natural history study. Two groups [GTPS group (n = 24), asymptomatic control (ASC) group (n = 20)] were evaluated at baseline, 12-months and 11-years. At 11-years all participants completed the modified Harris Hip Score (mHHS), Oswestry Disability Index (ODI) and Assessment of Quality-of-Life questionnaire. At 11-year follow-up 20/24 GTPS and 19/20 ASC participants were clinically assessed for GTPS and hip OA, completed the 10 metre-walk-test, timed up and go, and hip abduction and external rotation strength testing.ResultsAt 11-year follow-up 45.0% of GTPS participants had GTPS compared to 5.3% of ASC participants (p = 0.008), OR [95% CI]: 10.19 [1.95, 104.3], and 35.0% of GTPS participants were clinically diagnosed with hip OA compared to none of the ASC participants (p = 0.002), OR [95% CI]: 21.6, [2.3, 2898.0]. GTPS participants reported more pain and disability than ASC participants via the ODI, mean difference [95% CI]: 6.1 [0.7, 11.6] but not the modified Harris Hip Score, mean difference [95% CI]: -3.3 [-10.3, 3.7]. Both groups had similar levels of quality of life and measures of function.ConclusionsGTPS is a chronic condition: people with GTPS at baseline had twice the odds of being clinically diagnosed with GTPS or hip OA than the control group at 11-years. Further, there appears to be a temporal relationship between GTPS and the development of hip OA. This finding highlights the need to identify effective treatments that address the underlying impairments associated with GTPS. Pain and function results varied depending on the assessment tools used. Between group differences in quality of life seen at baseline are not found at the 11-year follow-up. The small sample size means the results must be considered with caution.Level of EvidenceLevel II Natural history Study.

Factors associated with hip pain in end-stage renal disease patients on prevalent hemodialysis: a cross-sectional study

BackgroundHemodialysis (HD) patients suffer from musculoskeletal disorders. The most reported musculoskeletal problem is arthralgia. Hip arthralgia has been commonly reported in patients undergoing HD. Hip pain can lead to a decrease in levels of physical activity, limitation in joint range of motion, and consequently difficulties in performing activities of daily living (ADL) and impair the quality of life (QoL). The aim of the study is to reveal the prevalence of hip pain and related factors in HD patients. This cross-sectional study included 73 patients on prevalent HD whose ages ranged from 25 to 65 years and who were on HD for more than 6 months. Physical examination and radiological imaging were done to every patient. Visual analog scale, Barthel Index, and Short Form-36 were used to evaluate pain, ADL, and QoL, respectively.ResultsHip arthralgia was detected in 32 patients. Around 43% of which were diagnosed hip osteoarthritis, 34% greater trochanteric pain syndrome, 15% femoroacetabular impingement, and 6% soft tissue calcifications. Diabetes mellitus and hemodialysis duration were found to be significantly different between the groups of hip pain and without hip pain. Diabetes mellitus was identified as an independent risk factor for hip pain in hemodialysis patients. ADL and QoL were significantly lower in patients with hip pain compared to those without (p < 0.01; p < 0.05, respectively).ConclusionsThe results of our research show that HD patients should be screened for the presence of hip pain and other musculoskeletal disorders and that this is an area which requires further consideration and medical research.

Greater trochanteric pain syndrome: predicting who will respond to a local glucocorticoid injection

Objectives: This study aimed to explore whether certain clinical tests or a rapid improvement in lateral hip pain following periarticular injection are predictive of subsequent efficacy of local glucocorticoid (GC) injection in greater trochanteric pain syndrome (GTPS). Method: This secondary analysis of a randomized controlled trial of an injection of GC and local anaesthetic (LA) versus placebo included 44 patients with GTPS. Two subgroups of patients were defined: (i) 30 min responders, reporting a decrease of ≥ 50% of the initial pain at 30 min post-injection; and (ii) positive triple test, presenting a combination of three positive clinical tests (30-second single-leg stance, FABER, and Lequesne). Median level of numeric rating scale for pain at 1 month was the primary outcome. Interaction analysis of treatment effect in the subgroups was performed using a linear regression adjusting for pain at baseline. Results: Sixteen patients (36%) were 30 min responders. In this group, GC treatment was associated with a significant improvement in pain at 1 month compared to non-responders (p = 0.03). The 30 min response was not associated with the use of LA. Positive triple test (22% of patients) was associated with higher pain scores at baseline (p = 0.03). In this group, patients who received placebo had significantly more pain at 1 month than those with the cortisone injection (p = 0.04). Conclusion: Patients with GTPS who present a rapid decrease in pain after periarticular injection, and those who display a combination of three specific clinical tests, are more likely to benefit from an injection with GC and anaesthetic.

An indirect evaluation between corticosteroid injections and gluteal exercises in the management of pain in greater trochanteric pain syndrome

Introduction Greater trochanteric pain syndrome (GTPS) is an umbrella term used to describe several pathologies contributing to lateral hip pain. The most prevalent pathology is gluteal tendinopathy. Conservative management of GTPS is predominantly now focused on the use of corticosteroid injections (CSIs) and gluteal exercises. Aim To compare CSIs and gluteal exercises on pain in adults with GTPS. Method A systematic search of AMED, CINAHL, MEDLINE, EMBASE, TRIP and the Cochrane Library was conducted from inception to January 2021. Critical appraisal was completed using the Critical Appraisal Skills Programme tool. Data were extracted to obtain population characteristics and procedural details. Results Seven articles met the eligibility criteria out of a total of 336; five articles were randomised control trials (RCT) and two were cohort studies, equivalent to 758 and 70 participants, respectively. Studies generally reported significant benefits of CSIs <12 weeks and gluteal exercises >8 weeks for the reduction in lateral hip pain (p < .05). Critical appraisal demonstrated varied study quality and significant heterogeneity. Conclusion CSIs appear to be a successful treatment intervention in the short-term to decrease lateral hip pain but not in the long-term. Gluteal exercises plus education on avoiding tendon compression appears to be as successful as CSIs in the short and superior in the long-term.

Greater trochanteric pain after primary total hip replacement, comparing the anterior and posterior approach: A secondary analysis of a randomized trial

BackgroundGreater trochanteric pain (GTP) after total hip replacement is a common cause of residual lateral hip pain, regardless of the approach used. The goal of our study was to evaluate GTP after a direct anterior approach (DAA) compared to a posterior approach (PA) as well as the clinical outcomes of both approaches and answer the following: 1) What is the incidence of trochanteric pain after primary THA with two different surgical approaches? 2) What is the functional outcome of patients with GTP? 3) What proportion of patients with GTP resort to peritrochanteric injections? HypothesisOur hypothesis is that GTP is present with both approaches but satisfaction is lower with the PA. Patients and methodsA secondary analysis of a previously published clinical trial with 55 total hip arthroplasty patients randomized in one of two surgical approaches: 27 patients underwent the anterior modified Hueter approach, while the other group of 28 patients were operated using the posterior approach. Study outcomes were Modified Harris Hip Score (MHHS), satisfaction score, pain when lying on the affected side, and requiring an injection. Hip offset, femur lateralization and leg lengthening were measured before and after surgery. ResultsForty-five patients were available for complete follow-up at a mean of 62 months (range: 48–74). The incidence of GTP was higher in the posterior approach [PA: 6/21 (29%) vs DAA 4/24 (17%)) (p=0.3). Patients operated through a PA experienced more pain [5/21 (24%) of patients; VAS=mean 5.3] when lying on their operated side, compared to DAA patients [2/24 (8%) of patients; VAS=mean 2) (p=0.2)]. However, MHHS, patient satisfaction with surgery, radiological assessment for hip offset, femur lateralization or leg lengthening, and injections required were similar for both approaches. Overall, satisfaction and functional outcome with surgery was significantly lower in GTP patients, regardless of the approach. ConclusionsGTP impacts patient satisfaction and functional outcome in total hip arthroplasty patients. PA patients reported more trochanteric pain than DAA patients, which affected their clinical outcome. Level of evidenceIII.

Evidenced-Based Management of Greater Trochanteric Pain Syndrome

This paper aims to review the evidenced-based management of greater trochanteric pain syndrome (GTPS). There are various studies evaluating greater trochanteric pain syndrome that illustrate the mainstay of treatment is activity modification with the implementation of isometric and isotonic exercise programs. If conservative care fails, short-term benefits can be seen with corticosteroid injections. More refractory cases of GTPS should be referred for diagnostic ultrasound evaluation to illustrate gluteal tendinosis that could benefit from a targeted treatment such as percutaneous tenotomy or orthobiologics. GTPS is a common cause of lateral hip pain that typically requires a multimodal diagnostic and therapeutic approach that should be individualized based on patient-centered care. Treatments should take into consideration the individual’s overall health to develop a comprehensive treatment plan that utilizes both conservative and interventional modalities to maximize recovery.

Greater Trochanteric Pain Syndrome: Efficacy of Ultrasound Guided Platelet-rich Plasma vs Needle Tenotomy, Randomised Controlled Trial

Greater Trochanteric Pain Syndrome: Efficacy of Ultrasound Guided Platelet-rich Plasma vs Needle Tenotomy, Randomised Controlled Trial

Conventional and Arthrographic Magnetic Resonance Techniques for Hip Evaluation: What the Radiologist Should Know.

Over the last 2 decades, the definition of pathomechanical concepts that link osseous deformities to chondrolabral damage and expose young and active patients to the risk of early osteoarthritis has led to a tremendous increase in the number of joint-preserving surgeries performed. The rise in arthroscopic procedures has led to an increasing demand for comprehensive preoperative magnetic resonance imaging (MRI) assessment of the hip joint. This includes conventional MRI for the assessment of extra-articular and periarticular pathologies such as greater trochanteric pain, deep gluteal pain syndrome, and sports injuries. Magnetic resonance arthrography with or without traction is reserved for the accurate evaluation of deformities associated with impingement and hip instability and for detecting the resulting intra-articular lesions. This article summarizes the current standard imaging techniques that the radiologist should know. It also explores the potential of computer-assisted analysis of three-dimensional MRI for virtual impingement simulation and volumetric analysis of cartilage composition and geometry.

Development of techniques for greater trochanter fragment fixation during surgical treatment of the dysplastic coxarthrosis

Isolated fractures of the greater trochanter based on the sources of specialized literature on the subject are extremely rare. However, methods for fixing the greater trochanter are actively developed in connection with the use of various versions of trochanteric osteotomies in the surgical treatment of the dysplastic hip joint.&#x0D; In this article, the anatomical features of the proximal femur, development of the ideas of reattachment of the greater trochanter in the course of total hip arthroplasty, as well as the current state of the problem, were examined. Until recently, patches were used that were fixed to the thigh using the aid of wires for osteosynthesis of a large trochanter. In 2009, studies initially reported on the use of locking plates for osteosynthesis of the trochanter in total hip arthroplasty.&#x0D; Currently, greater trochanter fixation by locking plates shows the best results as previous fixation devices. However, patients sometimes experience greater trochanter pain syndrome after fixation fragment by plates. The analysis of the published works confirmed the relevance of the search for a new more advanced technique and a device for the reattachment of the greater trochanter to the femur in the surgical treatment of the dysplastic hip joint.

A double blind randomised control trial investigating the efficacy of platelet rich plasma versus placebo for the treatment of greater trochanteric pain syndrome (the HIPPO trial): a protocol for a randomised clinical trial

BackgroundGreater trochanteric pain syndrome (GTPS) is a painful condition characterised by pain around the greater trochanter usually affecting middle-aged women. The majority of patients will improve with conservative management such as physiotherapy and non-steroidal anti-inflammatory drugs (NSAIDs); however, if this fails then more invasive treatments including corticosteroid injections and surgery may be required. Platelet-rich plasma (PRP) is an autologous blood product, which has a higher concentration of growth factors postulated to provide enhanced healing and anti-inflammatory properties. There have been numerous studies on PRP’s efficacy in musculoskeletal soft tissue conditions with similar pathology to GTPS, with varying results, most promising being in plantar fasciopathy and patellar tendinopathy. Corticosteroids are the established second-line treatment, but do not always work long term. PRP may be a suitable alternative to corticosteroid in GTPS with longer-term effects; however, there are very limited reports. The Hip Injections PRP Vs Placebo (HIPPO) trial aims to assess the ability of PRP to improve symptoms and function in patients with GTPS.Methods/designHIPPO is a single-centre, double-blind randomized placebo-controlled study in patients with a radiologically confirmed diagnosis of gluteus medius or minimus tendinopathy with swelling within the tendon insertion with or without bursitis. We aim to randomise 102 patients with GTPS to either the PRP or placebo (normal saline injection) treatment arm. Participants will receive one ultrasound (US) guided PRP/placebo injection into the trochanteric bursa and surrounding gluteus medius/minimus tendons. The primary outcome measure is the International Hip Outcome Tool-12. Secondary outcome measures will include a visual analogue score for pain, the three-level version of the EuroQol five-dimensional questionnaire and the modified Harris Hip Score. Outcomes will be measured at baseline, 3, 6 and 12 months. Participants will have the option at 6 months to have a repeat blinded injection or cross over to PRP. Analyses of primary and secondary outcomes will be made according to the intention-to-treat principle. The trial reporting will comply with Consolidated Standards of Reporting Trials (CONSORT) guidelines.DiscussionThe HIPPO study has been designed to test the hypothesis that PRP is effective in treating GTPS in patients who have failed conservative management and to assess the duration of effect of PRP.Trial registrationClinicalTrials.gov, NCT03479190. Registered on 27 March 2018.

Comparative analysis between dynamic hip screw and proximal femoral nail the management of intertrochanteric femoral fracture

Peritrochanteric fractures are common in the elderly people. The frequency of these fractures has increased primarily due to the increasing life span and more sedentary life style brought on by urbanization. There are various forms of internal fixation devices used for Peritrochanteric Fractures. The most commonly used devices are the Dynamic Hip Screw (DHS) with Side Plate assemblies and proximal femoral nail (PFN). The present study was conducted in 30 cases of stable intertrochantric fractures of femur, classified according to AO classification. All patients were regularly followed up and Harris Hip Score was used for evaluation for the results. All the patients of stable intertrochantric fracture treated with PFN or DHS were allowed partial weight bearing at 4 weeks and full weight bearing at 15 weeks. Most of the patients treated with DHS had excellent outcome (86.66%) as compare to the patient treated with PFN having excellent outcome in 53.33%. Among complications for PFN difficult reduction was seen in 1 patient (6.6%), greater trochanter fracture was seen in 1 patient (6.6%), Hip pain was seen in 1 patient (6.6%) and shortening (> 1cm) was seen in 1 patient (6.6%). In DHS, common complications were superficial infection in 1 patient (6.6%), Hip Pain in 1 patient (6.6%) and shortening (> 1cm) in 3 patients (20%). The range of motion calculated by the Harris Hip Scoring system treated by both the implants i.e. PFN and DHS was good and was almost the same (95% CI:0.83P1.30,P=0.72). Both implants had equal time of union and had few complications in stable fractures but at long term follow up most of patient operated with PFN complained of implant related complications like greater trochanter Pain and anterior thigh pain.

Do features of central sensitisation exist in Greater Trochanter Pain Syndrome (GTPS)? a case control study

Do features of central sensitisation exist in Greater Trochanter Pain Syndrome (GTPS)? a case control study

Demystifying the clinical diagnosis of greater trochanteric pain syndrome

Demystifying the clinical diagnosis of greater trochanteric pain syndrome

AKT question relating to greater trochanteric pain syndrome

AKT question relating to greater trochanteric pain syndrome