Efficacy of Treatment of Trochanteric Bursitis: A Systematic Review

Abstract

Objective Trochanteric bursitis (TB) is a self-limiting disorder in the majority of patients and typically responds to conservative measures. However, multiple courses of nonoperative treatment or surgical intervention may be necessary in refractory cases. The purpose of this systematic review was to evaluate the efficacy of the treatment of TB. Data Sources A literature search in the PubMed, MEDLINE, CINAHL, and ISI Web of Knowledge databases was performed for all English language studies up to April 2010. Terms combined in a Boolean search were greater trochanteric pain syndrome, trochanteric bursitis, trochanteric, bursitis, surgery, therapy, drug therapy, physical therapy, rehabilitation, injection, Z-plasty, Z-lengthening, aspiration, bursectomy, bursoscopy, osteotomy, and tendon repair. Study Selection All studies directly involving the treatment of TB were reviewed by 2 authors and selected for further analysis. Expert opinion and review articles were excluded, as well as case series with fewer than 5 patients. Twenty-four articles were identified. According to the system described by Wright et al, 2 studies, each with multiple arms, qualified as level I evidence, 1 as level II, 1 as level III, and the rest as level IV. More than 950 cases were included. Data Extraction The authors extracted data regarding the type of intervention, level of evidence, mean age of patients, patient gender, number of hips in the study, symptom duration before the study, mean number of injections before the study, prior hip surgeries, patient satisfaction, length of follow-up, baseline scores, and follow-up scores for the visual analog scale (VAS) and Harris Hip Scores (HHS). Data Synthesis Symptom resolution and the ability to return to activity ranged from 49% to 100% with corticosteroid injection as the primary treatment modality with and without multimodal conservative therapy. Two comparative studies (levels II and III) found low-energy shock-wave therapy (SWT) to be superior to other nonoperative modalities. Multiple surgical options for persistent TB have been reported, including bursectomy (n = 2), longitudinal release of the iliotibial band (n = 2), proximal or distal Z-plasty (n = 4), osteotomy (n = 1), and repair of gluteus medius tears (n = 4). Conclusions Efficacy among surgical techniques varied depending on the clinical outcome measure, but all were superior to corticosteroid therapy and physical therapy according to the VAS and HHS in both comparison studies and between studies. This systematic review found that traditional nonoperative treatment helped most patients, SWT was a good alternative, and surgery was effective in refractory cases.

The management of greater trochanteric pain syndrome: A systematic literature review

“…The most common examination finding is reproduction of the pain on palpation of the greater trochanter. 18,19 GTPS affects between 1.8 and 5.6 patients per 1000 per year, more frequent between 40 and 60 years, predominantly female, 4,14 and possibly related to pelvic biomechanics.…”

“…12,13 GTPS is self limiting for the majority. 14,15 A few cases persist despite treatment and time; these cases are known as refractory cases and may require surgical intervention in the form of bursectomy, iliotibial band (ITB) lengthening techniques or gluteal tendon repair. 2 At present, there is no defined treatment protocol for GTPS.…”

“…2 At present, there is no defined treatment protocol for GTPS. 14,16 The criteria for when surgical intervention for refractory cases of GTPS is indicated are not presently well established. 17 The specific enquiry of this review is to determine the most effective treatment protocol for GTPS.…”

Hip Abductor Tendinopathy: Work-Up and Open Versus Arthroscopic Repair of Hip Abductor

“…Nonoperative treatment involves physical therapy, cortisone injections, local anesthetic injections, and nonsteroidal antiinflammatory medications [12,25]. Non-surgical management has been largely successful in patients with GTPS; trochanteric bursitis touts a similar response [9,26]. Adjuncts like plateletrich plasma injections continue to be investigated for many musculoskeletal diseases including tendinopathies but have not shown promise [12,27,28].…”

Hip arthroscopy for extra-articular hip disease

“…The trochanteric bursa, the largest bursa, sits deep to the fibers of the gluteus maximus and tensor fascia lata (TFL) as they form the iliotibial band (ITB) while covering the posterior facet, the distal-lateral medius tendon at the lateral facet, and the proximal vastus lateralis insertion [9][10][11][12]. True GTB is inflammation of one of the bursae about the greater trochanter, most commonly those associated with the gluteus medius and minimus tendons, ITB, or TFL, resulting in lateral hip pain [13][14][15]. This inflammation is thought to be the result of preexisting gait abnormalities such as with spinal pathology, gynecoid pelvis, or tight TFL or gluteal musculature with repetitive activity [13,[15][16][17][18].…”