Outcomes and cost-effectiveness of ultrasound-guided injection of the trochanteric bursa

Abstract

We hypothesized that ultrasound (US) guidance improves outcomes of corticosteroid injection of trochanteric bursitis. 40 patients with greater trochanteric pain syndrome defined by pain to palpation over the trochanteric bursa were randomized to injection with 5 ml of 1% lidocaine and 80 mg of methylprednisolone using (1) conventional anatomic landmark palpation guidance or (2) US guidance. Procedural pain (Visual Analogue Pain Scale), pain at outcome (2 weeks and 6 months), therapeutic duration, time-to-next intervention, and costs were determined. There were no complications in either group. Ultrasonography demonstrated that at least a 2-in (50.8 mm) needle was required to consistently reach the trochanteric bursa. Pain scores were similar at 2 weeks: US: 1.3 ± 1.9 cm; landmark: 2.2 ± 2.5 cm, 95% CI of difference: - 0.7 < 0.9 < 2.5, p = 0.14. At 6 months, US was superior: US: 3.9 ± 2.0 cm; landmark: 5.5 ± 2.6 cm, 95% CI of difference: 0.8 < 1.6 < 2.4, p = 0.036. However, therapeutic duration (US 4.7 ± 1.4 months; landmark 4.1 ± 2.9 months, 95% CI of difference - 2.2 < - 0.6 < 1.0, p = 0.48), and time-to-next intervention (US 8.7 ± 2.9 months; landmark 8.3 ± 3.8 months, 95% CI of difference - 2.8 < - 0.4 < 2.0, p = 0.62) were similar. Costs/patient/year was 43% greater with US (US $297 ± 99, landmark $207 ± 95; p = 0.017). US-guided and anatomic landmark injection of the trochanteric bursa have similar 2-week and 6-month outcomes; however, US guidance is considerably more expensive and less cost-effective. Anatomic landmark-guided injection remains the method of choice, but should be routinely performed using a sufficiently long needle [at least a 2 in (50.8 mm)]. US guidance should be reserved for extreme obesity or injection failure.

Gluteus maximus tendon transfer for chronic abductor insufficiency: the Geneva technique

“…The outcomes of surgical treatment of abductor insufficiency depend on the type of tear, chronicity and the degree of muscle degeneration. 2,5 Many open and arthroscopic techniques have reported the successful repair of tendons in the primary setting. Adequate mobilisation and a limited degree of degeneration of the muscle are prerequisites for a beneficial outcome.…”

Clinical indications for image-guided interventional procedures in the musculoskeletal system: a Delphi-based consensus paper from the European Society of Musculoskeletal Radiology (ESSR)—part IV, hip

“…Agreement = 100% Injection therapies for trochanteric bursitis with palpation guidance or image guidance are both safe and effective for relieving GTPS, resulting in a significant reduction in pain up to three months [ 34 ]. Ultrasound- and palpation-guided injections of the trochanteric bursa have also shown similar clinical results at 2-week and 6-month follow-up [ 35 ]. According to some authors, benefit in pain reduction from ultrasound-guided trochanteric bursa corticosteroid-anesthetic injection might decrease at 6 and 12 months [ 36 , 37 ].…”

Superior gluteal nerve injury following landmark‐guided corticosteroid injection for greater trochanteric pain: A case report

“…When injecting other locations thought to be the source of the pain, ultrasound‐guided injections may be limited in visualizing the needle when injecting deep anatomical regions 14 . While ultrasound‐guided injections might not be cost‐effective for routine injections of trochanteric bursae, ultrasound‐guided injection may be useful in certain patient populations, that is, in extremely obese populations or in cases where prior anatomic landmark‐guided injections failed 15 . Careful consideration should be used to accurately and effectively administer corticosteroid injections to the pain‐producing regions contributing to GTPS.…”