Trochanteric spurs and surface irregularities on plain radiography are not predictive of greater trochanteric pain syndrome

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.

Greater trochanteric pain syndrome: Evaluation and management of a wide spectrum of pathology

“… 33 However, a recent study found that radiographic surface irregularities are not reliable indicators for clinically diagnosed GTPS, with enthesophytes measuring greater than 2 mm on plain radiographs demonstrating a sensitivity of only 64% and a specificity of 26%. 34 Plain radiographs are primarily useful for the diagnosis of alternative sources of hip pain, including osteoarthritis, avascular necrosis, femoroacetabular impingement, and lumbar spondylosis.…”

Restoration of leg length and offset correlates with trochanteric pain syndrome in total hip arthroplasty

“…Barrett et al mention a series prevalence of 27.5%. In addition MRI analysis show peritrochanteric lesion in over 30% [4][5][6] . Following total hip arthroplasty (THA) 4-17% of patients report these symptoms according to previous studies [7][8][9][10][11] .…”

Pertrochanteric Calcifications in Patients With Greater Trochanteric Pain Syndrome: Description, Prevalence, and Correlation With Intraoperatively Diagnosed Hip Abductor Tendon Injuries

“…33 Last, the study by Barrett et al included only 38 patients with GTPS, while the present study constitutes the largest series to date on patients with GTPS, with 713 hips included. In contrast to Barrett et al, 1 Hartigan et al 16 reported that proximally directed enthesophytes are a significant predictor for an abductor tendon tear, with an OR of 20.7. This is significantly higher than the value reported in the current study; however, the reference groups are different in the 2 studies.…”

“…Subsequent studies have evaluated the association of pertrochanteric calcifications with GTPS with conflicting results. 1,16,29,32 However, to date, no studies have systematically described pertrochanteric calcifications in a large series of patients presenting with GTPS. Furthermore, no studies have evaluated the association between various types of pertrochanteric calcifications and surgically assessed tendon injuries.…”