No abstract

Purpose: Surface irregularities of the greater trochanter have been described as a potential radiographic sign of greater trochanteric pain syndrome (GTPS). We report a diagnostic accuracy study to evaluate the clinical usefulness of trochanteric surface irregularities on plain radiographs in the diagnosis of GTPS. Methods: We retrospectively identified the anteroposterior pelvic radiographs of a consecutive group of 38 patients (representing a 27.5% series prevalence) diagnosed with GTPS (mean age 69.5 years ± 16.1 [standard deviation], 27 females, 11 males) based on clinical symptoms and a positive response to a local anaesthetic and steroid injection. A control group consisted of 100 patients (mean age 73 years ± 17.1 [standard deviation], 67 females, 33 males) with either hip osteoarthritis listed for hip arthroplasty ( n = 50), or with an intracapsular neck of femur fracture ( n = 50) both presenting between January and July 2017. Radiographs were cropped to blind observers to the presence of hip osteoarthritis or intracapsular fracture but included the trochanteric region. The radiograph sequence was randomised and separately presented to 3 orthopaedic surgeons to evaluate the presence of trochanteric surface irregularities. Results: The inter-observer correlation coefficient agreement was acceptable at 0.75 (95% CI, 0.60–0.84). Trochanteric surface irregularities including frank spurs protruding ⩾2 mm were associated with a 24.7% positive predictive value, 64.0% sensitivity, 25.7% specificity, 74.3% false-positive rate, 36.0% false-negative rate, and a 65.3% negative predictive value for clinical GTPS. Conclusion: Surface irregularities of the greater trochanter are not reliable radiographic indicators for the diagnosis of greater trochanteric pain syndrome.

Purpose Surgery for greater trochanteric pain syndrome (GTPS) may be indicated for cases refractory to conservative measures. We aim to evaluate patient reported outcomes and adverse events following surgery. Methods Postal questionnaires were used to evaluate a consecutive series of 61 bursectomy and gluteal fascia transposition (GFT) procedures. Study outcomes were Oxford hip score, satisfaction score, visual analogue score, pain lying on the affected side, and the duration of pain relief after surgery. Results We received responses regarding 52 procedures at a median of 34 months follow-up; 40% of cases of GTPS occurred following THA. We observed a bimodal distribution of satisfaction scores. The early post-operative complication rate was 13%; an additional seven cases (12%) required further surgery at a later date. Idiopathic GTPS had significantly better post-operative satisfaction than GTPS following THA, 87.5 vs. 37.5 (p = 0.006); Oxford hip scores, 35 vs. 15 (p = 0.015); and visual analogue scores, 20 vs. 73 (p = 0.005). Conclusion We observed overall poor outcomes, significant complications and concerning reoperation rates. Cases with previous joint replacement were associated with the worst outcomes.

The BAUS consensus statement [1] provides the latest update to guidance on management of bladder injury (BI). Clinical guidelines are a particularly helpful tool for such cases, which are uncommon, but require timely diagnosis and management to optimise outcome.Before 2021, the European Association of Urology (EAU) Guidelines on Urological Trauma [2] and British Orthopaedic Association Standard for Trauma (BOAST)14 [3] provided guidance on the best practice for management of traumatic BI, which are commonly secondary to blunt trauma (e.g. road traffic accidents) and associated with multiple injuries, especially pelvic fracture. The EAU guidance [2] also details the suggested management of iatrogenic BI. Regardless of aetiology, the management of extra-and intraperitoneal injuries is distinct, therefore accurate diagnosis is important.