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Study questions inflammation as a component of trochanteric bursitis
Biopsies of the subtrochanteric bursa did not show inflammation in patients with 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 vs. controls.
“Our hypothesis appears correct, that there does not appear to be an inflammatory component to trochanteric bursitis asit is currently diagnosed,” Simon Hughes, BSc, MB ChB, MRCS(Ed), said.
Hughes is a specialty training registrar in orthopaedics and traumatology at North Western Deanery, Wrightington Hospital, in Wigan, United Kingdom.
Trochanteric bursitis is now considered part of greater trochanteric pain syndrome (GTPS), a regional pain syndrome, he said, and noted GTPS is an umbrella term that includes iliotibial band disorder, associated medius limitus and trochanteric bursitis.
Wait-listed patients studied
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 osteoarthritis at the Centre for Hip Surgery 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 trochanteric 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 by surgeons
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 there were no statically significant differences between the case and control groups in terms of preoperative variables.
“In terms of the lack of inflammation in the trochanteric bursitis positive group, this did prove statistically significant,” he said.
Five patients in the control group had abnormalities of the abductor tendon insertion whereas only one patient in the control group showed changes.
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.
Tim N. Board, MRCS, MSc(Orth Eng), FRCS(Trauma & Orth), the study’s senior author, told Orthopaedics Today Europe, “This study highlights the importance of trying to find the exact cause of pain in patients previously diagnosed as “trochanteric bursitis,” as this is likely to guide more successful treatment in the future.” – by Susan M. Rapp
- Reference:
- Hughes S. Trochanteric bursitis: Does it really exist? Presented at: British Orthopaedic Association Congress; Sept. 11-14, 2012; Manchester.
- For more information:
- Tim N. Board, MRCS, MSc(OrthEng), FRCS(Trauma & Orth), can be reached at Wrightington Hospital, Hall Lane, Appley Bridge, Wigan WNG 9EP, United Kingdom; email: tim.n.board@wwl.nhs.uk.
Disclosure: The study was partially funded by Wrightington R&D fund.