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Wittauer M, Stoffel K. An Unconventional Solution for Persistent Lateral Hip Prosthetic Friction Syndrome (LHPFS) after Revision Total Hip Arthroplasty. Case Rep Orthop 2024; 2024:7934419. [PMID: 38665697 PMCID: PMC11045277 DOI: 10.1155/2024/7934419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 03/26/2024] [Accepted: 04/08/2024] [Indexed: 04/28/2024] Open
Abstract
We report on a 77-year-old male patient, who presented with excessive bone loss at the area of the greater trochanter after several hip revision surgeries resulting in a persistent friction syndrome caused directly by the rough surface and sharp edges of the prosthetic shoulder of a well-fixed Wagner-type revision stem. Surgery was performed by creating a cemented neotrochanter with an attached polyester patch around the proximal lateral shaft and performing a Z-plasty of the iliotibial tract. Twelve months postoperatively, the patient reported a reduction in subjective pain of 50% and improvement of the Harris Hip Score from 45 to 75 points. Without a definition in the current literature, the authors propose the term "lateral hip prosthetic friction syndrome" (LHPFS) to describe this medical condition.
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Affiliation(s)
- Matthias Wittauer
- Department of Trauma and Orthopaedic Surgery, University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Karl Stoffel
- Department of Trauma and Orthopaedic Surgery, University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
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Alkan H, Karaman Y, Güven Ş, Biçici V, Subaşı İÖ, Yaşar NE, Fırat A. Are There Any Significant Risk Factors Associated with Lateral Trochanteric Pain in Patients Who Have Undergone Primary Hip Replacement? Cureus 2023; 15:e44863. [PMID: 37809213 PMCID: PMC10560105 DOI: 10.7759/cureus.44863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2023] [Indexed: 10/10/2023] Open
Abstract
Introduction Lateral pain around the greater trochanter (LTP) is a common complication after total hip arthroplasty (THA) that can significantly reduce quality of life. The aim of this study was to analyze the relationship between lateral trochanteric bursa repair, subcutaneous fat thickness, and trochanteric pain during the THA procedure. Materials and methods A total of 98 patients who underwent THA for hip arthrosis between 2021 and 2022 were evaluated retrospectively. For all evaluated patients, subcutaneous thickness was measured between the fascia and the skin at the incision site. Bursa repair was performed in 47 patients, while bursa excision was done in 51 patients. The data obtained included demographic information, functional scores, comorbidities, bursa repair and skin thickness values, radiographic evaluations, and other specific markers. These were compared between patients diagnosed with LTP following THA and the controls. Results No difference was observed between the study groups in terms of subcutaneous fat thickness, bursa repair, and other demographic or radiographic evaluations. As expected, there were statistically significant differences between the groups in terms of the visual analog scale (VAS) score (p=0.030) and the Harris hip score (HHS) (p=0.045). When comparing the groups with and without LTP, the VAS score was higher in the group with LTP, while the HHS was found to be lower. Conclusion Trochanteric pain is not associated with bursa repair or subcutaneous thickness. LTP cannot be predicted based on comorbidities such as smoking, BMI, or radiographic measurements.
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Affiliation(s)
- Hilmi Alkan
- Orthopaedics and Traumatology, Ankara Bilkent City Hospital, Ankara, TUR
| | - Yavuz Karaman
- Orthopaedics and Traumatology, Ankara Bilkent City Hospital, Ankara, TUR
| | - Şahan Güven
- Orthopaedics and Traumatology, Ankara Bilkent City Hospital, Ankara, TUR
| | - Vedat Biçici
- Orthopaedics and Traumatology, Ankara Bilkent City Hospital, Ankara, TUR
| | - İzzet Özay Subaşı
- Orthopaedics and Traumatology, Erzincan University Faculty of Medicine, Erzincan, TUR
| | - Niyazi Erdem Yaşar
- Orthopaedics and Traumatology, Ankara Bilkent City Hospital, Ankara, TUR
| | - Ahmet Fırat
- Orthopaedics and Traumatology, Ankara Bilkent City Hospital, Ankara, TUR
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Chalidis BE, Sachinis NP, Hawdon G, McMahon S. Lateral trochanteric bursa repair improves early hip function after posterior approach total hip arthroplasty: a prospective randomized control trial. ARTHROPLASTY 2022; 4:26. [PMID: 35668516 PMCID: PMC9169311 DOI: 10.1186/s42836-022-00127-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 05/25/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The trochanteric bursa (TB) is an anatomic structure, which is dissected during posterior/lateral hip approaches in Total Hip Arthroplasty (THA). Some surgeons prefer to simply resect the bursa as they believe that it may be responsible for postoperative lateral trochanteric pain (LTP). Others advocate that this tissue acts as a buffer minimizing friction between soft tissue and bone, and therefore its repair may prevent LTP after THA. AIM The purpose of this prospective randomized controlled trial was to compare the clinical results of either resecting or repairing the TB during posterior approach THA. METHODS Forty-two patients with primary hip osteoarthritis undergoing THA via a posterior hip approach were randomly assigned to two groups; Group A, or TB resection group and Group B, or TB repair group. All patients in both groups were evaluated postoperatively in terms of hip function, measured by the Harris Hip Score (HHS), at 6 weeks, 3 months, 6 months, and 12 months after surgery, as well as LTP during daily routine activities and lying on the operative side. RESULTS Forty patients completed the study. Postoperative difference in terms of leg length and femoral offset was similar among the two groups (P = 0.467 and P = 0.39, respectively). At 6 weeks, patients in Group B had higher HHS (P = 0.052) and experienced less LTP when lying on the operative side (P = 0.046) but not during activities (P = 0.759). Thereafter, all functional parameters measured had comparable values in both groups. Subgroup analysis failed to identify any correlation between high offset stems and LTP. CONCLUSION TB repair in posterior approach THA improves hip functional recovery as well as patients' ability to lie on the operative side during the early postoperative period.
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Affiliation(s)
- Byron E. Chalidis
- Malabar Orthopaedic Clinic, 43 The Avenue, Windsor, Melbourne, 3181 Australia
| | - Nick P. Sachinis
- Malabar Orthopaedic Clinic, 43 The Avenue, Windsor, Melbourne, 3181 Australia
| | - Gabrielle Hawdon
- Malabar Orthopaedic Clinic, 43 The Avenue, Windsor, Melbourne, 3181 Australia
| | - Stephen McMahon
- Malabar Orthopaedic Clinic, 43 The Avenue, Windsor, Melbourne, 3181 Australia
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A Cutaneous Transposition Inversion Flap to Treat Symptomatic Subcutaneous Trochanteric or Soft Tissue Defects After Hip Arthroplasty: A Technical Note. Tech Orthop 2022. [DOI: 10.1097/bto.0000000000000591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Bateman D, Wang M, Mennona S, Kayiaros S. Incidence of and Risk Factors for Lateral Trochanteric Pain After Direct Anterior Approach Total Hip Arthroplasty. Orthopedics 2022; 45:e79-e85. [PMID: 34978513 DOI: 10.3928/01477447-20211227-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Lateral trochanteric pain (LTP) is a common complication after total hip arthroplasty (THA). The goals of this study were to report the incidence of LTP after direct anterior approach (DAA) THA, describe the treatment course and outcomes, and examine patient-specific and implant-related potential risk factors. A retrospective review identified patients who underwent primary DAA THA with at least 1-year follow-up. Postoperative functional outcome scores and LTP occurrence were recorded. Patient demographics, surgical indications, implant characteristics, medical comorbidities, and radiographic parameters were obtained. Logistic regression analysis was used to identify risk factors. A total of 610 THA procedures were performed for 563 patients (mean follow-up, 30.9±15.2 months). The overall incidence of LTP was 11.6%. All cases of LTP were successfully treated conservatively, although these patients, compared with patients who did not have postoperative LTP, experienced significantly lower functional outcome scores (Harris Hip Score, 96.6±4.7 [range, 55-100] vs 89.9±8.5 [range, 42-100], respectively; P<.001). Logistic regression analysis identified female sex (odds ratio, 2.30; 95% CI, 1.32-4.02), diabetes mellitus (odds ratio, 2.32; 95% CI, 1.11-4.88), hypertension (odds ratio, 1.94; 95% CI, 1.15-3.28), and the use of an offset acetabular liner (odds ratio, 2.50; 95% CI, 1.06-5.91) as independent risk factors for LTP. There was no correlation between LTP and radiographic parameters. The incidence of LTP after DAA THA is similar to reported rates for other THA surgical approaches. Female sex, medical comorbidities, and the use of offset acetabular liners are likely associated, and patients should be counseled appropriately. Postoperative LTP results in worse functional outcomes, although all cases can be treated conservatively. [Orthopedics. 2022;45(2):e79-e85.].
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Floerkemeier T. Patientenspezifische Planung in der Hüftendoprothetik. ARTHROSKOPIE 2021. [DOI: 10.1007/s00142-021-00461-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Lateral Trochanteric Pain Following Primary Total Hip Arthroplasty: Incidence and Success of Nonoperative Treatment. J Arthroplasty 2021; 36:193-199. [PMID: 32778414 DOI: 10.1016/j.arth.2020.07.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/08/2020] [Accepted: 07/16/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Our study aimed at quantifying the overall incidence of lateral trochanteric pain (LTP) following total hip arthroplasty (THA) and risk based on surgical approach. The success of conservative treatment and potential risk factors for failure of conservative treatment were evaluated. METHODS This is a retrospective review of patients who underwent primary THA between 2010 and 2019 and had a postoperative diagnosis of ipsilateral LTP. Chart review revealed patient demographics/comorbidities, preoperative diagnosis, surgical approach, femoral components, and nonoperative treatment modalities. Radiographic analysis was performed to measure leg length discrepancy, femoral offset, and femoral head lateralization. RESULTS The incidence of LTP following primary THA was 1.70% (573/33,761) with an average time to diagnosis of 27.3 months. The direct anterior approach demonstrated the highest risk and the direct lateral demonstrated the lowest risk for LTP (P < .001). Also, 82.4% (472/573) were diagnosed greater than 6 months postoperatively (P < .001). Of 573 patients, 95 (16.6%) were treated with physical therapy, home exercises, or oral medications with a success rate of 96.8% (92/95). Remaining 478 (83.4%) were treated with corticosteroid injection (CSI). And 89.5% (428/478) of the CSI cohort demonstrated clinical improvement with 3 or less CSIs. Risk factors for failure of conservative treatment were depression (P = .034), kidney disease (P = .040), and osteoporosis (P = .007). CONCLUSION Postoperative LTP after THA is rare with an incidence of 1.70%. The direct anterior approach presented higher risk of LTP. Non-CSI modalities and CSIs were both successful treatment options. In patients with depression, kidney disease, and osteoporosis, conservative treatment may be less efficacious.
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Biggi S, Banci L, Tedino R, Capuzzo A, Cattaneo G, Tornago S, Camera A. Restoring global offset and lower limb length with a 3 offset option double-tapered stem. BMC Musculoskelet Disord 2020; 21:646. [PMID: 33008343 PMCID: PMC7532558 DOI: 10.1186/s12891-020-03674-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 09/24/2020] [Indexed: 11/10/2022] Open
Abstract
Background A proper restoration of hip biomechanics is fundamental to achieve satisfactory outcomes after total hip arthroplasty (THA). A global hip offset (GO) postoperatively reduction of more than 5 mm was known to impair hip functionality after THA. This study aimed to verify the restoration of the GO radiographic parameter after primary THA by the use of a cementless femoral stem available in three different offset options without length changing. Methods From a consecutive series of 201 patients (201 hips) underwent primary cementless THA in our center with a minimum 3-year follow up, 80 patients (80 hips) were available for complete radiographic evaluation for GO and limb length (LL) and clinical evaluation with Harris hip score (HHS). All patients received the same femoral stem with three different offset options (option A with – 5 mm offset, option B and option C with + 5 mm offset, constant for each sizes) without changing stem length. Results Mean GO significantly increased by + 3 mm (P < 0.05) and mean LL significantly decreased by + 5 mm (P < 0.05) after surgery, meaning that postoperatively the limb length of the operated side increased by + 5 mm. HHS significantly improved from 56.3 points preoperatively to 95.8 postoperatively (P < 0.001). Offset option A was used in 1 hip (1%), B in 59 hips (74%) and C in 20 hips (25%). Conclusions The femur is lateralized with a mean of + 5 mm after surgery than, the native anatomy, whatever type of stem was used. Thus, the use of this 3-offset options femoral stem is effective in restoring the native biomechanical hip parameters as GO, even if 2 offset options were considered sufficient to restore GO.
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Affiliation(s)
- Stefano Biggi
- Clinica Città di Alessandria - Policlinico di Monza, via Moccagatta 30, 15122, Alessandria, AL, Italy. .,Fondazione Lorenzo Spotorno - Onlus, Albenga, SV, Italy.
| | | | - Riccardo Tedino
- Clinica Città di Alessandria - Policlinico di Monza, via Moccagatta 30, 15122, Alessandria, AL, Italy.,Fondazione Lorenzo Spotorno - Onlus, Albenga, SV, Italy
| | - Andrea Capuzzo
- Clinica Città di Alessandria - Policlinico di Monza, via Moccagatta 30, 15122, Alessandria, AL, Italy.,Fondazione Lorenzo Spotorno - Onlus, Albenga, SV, Italy
| | - Gabriele Cattaneo
- Clinica Città di Alessandria - Policlinico di Monza, via Moccagatta 30, 15122, Alessandria, AL, Italy.,Fondazione Lorenzo Spotorno - Onlus, Albenga, SV, Italy
| | | | - Andrea Camera
- Clinica Città di Alessandria - Policlinico di Monza, via Moccagatta 30, 15122, Alessandria, AL, Italy.,Fondazione Lorenzo Spotorno - Onlus, Albenga, SV, Italy
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Trochanteric pain and total hip arthroplasty: a systematic review of the literature. CURRENT ORTHOPAEDIC PRACTICE 2020. [DOI: 10.1097/bco.0000000000000884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Worlicek M, Messmer B, Grifka J, Renkawitz T, Weber M. Restoration of leg length and offset correlates with trochanteric pain syndrome in total hip arthroplasty. Sci Rep 2020; 10:7107. [PMID: 32345993 PMCID: PMC7188889 DOI: 10.1038/s41598-020-62531-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 03/13/2020] [Indexed: 02/06/2023] Open
Abstract
Persistent pain around the greater trochanter is a common complication after total hip arthroplasty. Restoration of biomechanics such as leg length, femoral und acetabular offset is crucial in THA. The purpose of this study was to evaluate postoperative differences of these parameters after THA and to analyze their association to greater trochanteric pain syndrome. Furthermore, we aimed to evaluate the clinical relevance of trochanteric pain syndrome compared to patient reported outcome measures. 3D-CT scans of 90 patients were analyzed after minimalinvasive total hip arthroplasty and leg length, femoral and acetabular offset differences were measured. Clinical evaluation was performed three years after THA regarding the presence of trochanteric pain syndrome and using outcome measures. Furthermore, the patients' expectation were evaluated. Patients with trochanteric pain syndrome showed a higher absolute discrepancy of combined leg length, femoral and acetabular offset restoration compared to the non-operated contralateral side with 11.8 ± 6.0 mm than patients without symptoms in the trochanteric region with 7.8 ± 5.3 mm (p = 0.01). Patients with an absolute deviation of the combined parameters of more than 5 mm complained more frequently about trochanteric symptoms (29.2%, 19/65) than patients with a biomechanical restoration within 5 mm compared to the non-affected contralateral side (8.0%, 2/25, p = 0.03). Clinical outcome measured three years after THA was significantly lower in patients with trochanteric symptoms than without trochanteric pain (p < 0.03). Similarly, fulfillment of patient expectations as measured by THR-Survey was lower in the patients with trochanteric pain (p < 0.005). An exact combined restoration of leg length, acetabular and femoral offset reduces significantly postoperative trochanteric pain syndrome and improves the clinical outcome of the patients.
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Affiliation(s)
- Michael Worlicek
- University of Regensburg, Department of Trauma Surgery, University Medical Center, Regensburg, Germany. .,University of Regensburg, Department of Orthopedic Surgery, Asklepios Medical Center, Bad Abbach, Germany.
| | - Benedikt Messmer
- University of Regensburg, Department of Orthopedic Surgery, Asklepios Medical Center, Bad Abbach, Germany
| | - Joachim Grifka
- University of Regensburg, Department of Orthopedic Surgery, Asklepios Medical Center, Bad Abbach, Germany
| | - Tobias Renkawitz
- University of Regensburg, Department of Orthopedic Surgery, Asklepios Medical Center, Bad Abbach, Germany
| | - Markus Weber
- University of Regensburg, Department of Orthopedic Surgery, Asklepios Medical Center, Bad Abbach, Germany
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Fan G, Xiang C, Li S, Gao Z, Liu X, He D, Sun J. Effect of placement of acetabular prosthesis on hip joint function after THA. Medicine (Baltimore) 2019; 98:e18055. [PMID: 31804311 PMCID: PMC6919440 DOI: 10.1097/md.0000000000018055] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The good recovery of hip function after THA depends on reconstruction of acetabular prosthesis accurately. So we investigated the effect of acetabular prosthesis placement on hip joint function after THA and analyzed the clinical data of 432 patients with unilateral THA retrospectively . The patients were followed-up to evaluate the Harris score and hip range of motion (ROM). The hip ROM, the Harris score and the good rate of Harris score were compared between different groups. Comparison of the good rate of Harris score showed that 85%∼100% group of the rotation center horizontal position ratio was higher than >100% group; 80%∼120% group of the rotation center vertical position ratio was higher than >160% group; and the 90%∼110% group and 110%∼130% group of femoral offset ratio were higher than 90% and >130% groups. Comparison of Harris score showed that 85%∼100% and 70%∼85% groups of rotation center horizontal position ratio were higher than 70% and >100% groups; 80%∼120% group of rotation center vertical position ratio was the highest; and 90%∼110% group and 110%∼130% group of femoral offset ratio were higher than >130% and 90% groups. Comparison of hip ROM showed that 85%∼100% and 70%∼85% groups of the rotation center horizontal position ratio were higher than 70% and >100% groups; 80%∼120% group of the rotation center vertical position ratio was the highest; and hip ROM from high to low are 90%∼110%, 110%∼130%, >130% and 90% groups of femoral offset ratio. These findings indicated that during the early follow-up period of THA, if the horizontal position of femoral head rotation center was reconstructed in 0.85 to 1 times of healthy side when compared with reconstruction >1 times of the healthy side and if the vertical position of femoral head rotation center was reconstructed in 0.8 to 1.2 times of the healthy side when compared with reconstruction in >1.6 times of the healthy side, better hip function recovery and optimal hip ROM were obtained. The optimal reconstruction range of femoral offset is 0.9 to 1.3 times of the healthy side.
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Hönle W, Scheller A, Goyal T, Schuh A. [Painful total hip arthroplasty - operative and conservative therapy]. MMW Fortschr Med 2019; 161:66-70. [PMID: 31691217 DOI: 10.1007/s15006-019-1064-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Wolfgang Hönle
- Muskuloskelettales Zentrum Klinikum Neumarkt, Akademisches Lehrkrankenhaus der Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberger Str. 12, D-92318, Neumarkt i. d. OPf., Deutschland.
| | - Alexander Scheller
- Muskuloskelettales Zentrum Klinikum Neumarkt, Akademisches Lehrkrankenhaus der Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberger Str. 12, D-92318, Neumarkt i. d. OPf., Deutschland
| | - Tarun Goyal
- Muskuloskelettales Zentrum Klinikum Neumarkt, Akademisches Lehrkrankenhaus der Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberger Str. 12, D-92318, Neumarkt i. d. OPf., Deutschland
| | - Alexander Schuh
- Muskuloskelettales Zentrum Klinikum Neumarkt, Akademisches Lehrkrankenhaus der Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberger Str. 12, D-92318, Neumarkt i. d. OPf., Deutschland
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