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Study questions inflammation as a component of trochanteric bursitis

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MANCHESTER — Bursal inflammation has been thought to be related to trochanteric bursitis. However, in an award-wining study presented at the British Orthopaedic Association Congress here, researchers found no acute or chronic inflammation of the trochanteric bursa in patients with a positive diagnosis of trochanteric bursitis.

“Our hypothesis appears correct, that there does not appear to be an inflammatory component to trochanteric bursitis as it is currently diagnosed,” Simon Hughes, BSc, MB ChB, MRCS(Ed), said.

Hughes is a specialty training registrar in orthopaedics and traumatology at North West Deanery, Wrightington Hospital, in Wigan, the United Kingdom. Trochanteric bursitis is now considered part of greater trochanteric pain syndrome (GTPS), a regional pain syndrome, he said.

Wait-listed patients

To determine whether the inflammatory component of trochanteric bursitis is a real phenomenon, Hughes and colleagues prospectively recruited 50 patients aged older than 18 years who were wait-listed for primary total hip arthroplasty (THA) secondary to rheumatoid arthritis or osteoarthritis at the Hip Centre at Wrightington Hospital. Patients excluded from the study included those who were taking steroids, had ipsilateral corticosteroid hip injections within the last 9 months, and had known low back pain or a known diagnosis of lateral hip pain, such as a gluteus medius tear confirmed on MRI, among others, Hughes said.

Four surgeons performed THA via a standard posterior approach in the 50 patients studied and harvested biopsies of the sub-gluteus maximus bursa. The study included preoperative assessment of such factors as age, gender, leg length discrepancy and range of motion and a clinical assessment for trochanteric bursitis done via the Rasmussen and Fano classification.

Assessment

An intraoperative assessment was done by each operating surgeon for the case group — patients with a trochanteric bursitis diagnosis — and the control group.

“An inspection of the gluteus medius and minimus tendons was carried out,” Hughes said.

Prof. A. Freemont, a histopathologist at the University of Manchester, performed independent and blinded postoperative assessments.

“The crux of the matter is that of all 50 samples sent for histological analysis by Prof. Freemont, not one showed acute or chronic inflammation,” Hughes said, noting no statically significant differences between the case and control groups in terms of preoperative variables.

A similar number of abnormal tendons were also noted in the case and control groups, about twenty in each.

“In terms of the lack of inflammation in the trochanteris bursitis positive group, this did prove statistically significant,” Hughes said.

Hughes received the Best of the Best Paper award at the meeting, a new award established this year for orthopaedic surgery trainees attending the Congress.

Reference:

Hughes S, Liptrott J, Freemont T, Board T. Trochanteric bursitis – does it really exist? Presented at the British Orthopaedic Association Congress 2012. Sept. 11-14. Manchester.

Disclosure: Hughes’ study was partially funded by the John Charnley Institute.