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Domb BG, Owens JS, Maldonado DR, Harris WT, Perez-Padilla PA, Sabetian PW. Favorable and Durable Outcomes at 10-Year Follow-Up After Endoscopic Gluteus Medius Repair With Concomitant Hip Arthroscopy. Arthroscopy 2024; 40:2215-2224. [PMID: 37967732 DOI: 10.1016/j.arthro.2023.10.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 10/23/2023] [Accepted: 10/26/2023] [Indexed: 11/17/2023]
Abstract
PURPOSE To evaluate 10-year patient-reported outcome (PRO) scores following endoscopic surgery for gluteus medius partial and full-thickness tears with concomitant hip arthroscopy for labral tears and/or femoroacetabular impingement syndrome (FAIS). METHODS Prospectively collected data on patients followed for a minimum of 10 years after endoscopic gluteus medius repair with concomitant hip arthroscopy performed by a single surgeon were retrospectively analyzed. Patients with preoperative and 10-year follow-up for the following PROs were included: modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), Hip Outcome Score-Sports Specific Subscale (HOS-SSS), and Visual Analog Scale (VAS) score for pain. RESULTS There were 13 patients eligible for inclusion, 11 (84.6%) of whom had 10-year follow up, with a mean of 127.6 months (range: 120.0-140.2 months). The group consisted of 10 females (90.9%) and one male (9.1%) with a mean age at surgery of 60.1 years (range: 46.2-74.8 years). PRO scores improved from preoperative to 10-year follow-up as follows: mHHS from 60.4 to 88.0 (P = .011); NAHS from 50.1 to 90.6 (P < .001); HOS-SS from 37.5 to 85.1 (P = .001); and VAS from 4.8 to 1.2 (P = .006). Mean patient satisfaction rating was 8.3. Patients achieved PASS and MCID for mHHS and HOS-SSS at a rate of 81.8%. There was no significant decline in PROs or satisfaction between 2, 5, and 10 years postoperatively. All patients underwent concomitant hip arthroscopy and labral treatment (debridement or repair). One patient, who had arthroscopic findings of acetabular and femoral outerbridge grade 4 lesions, subsequently underwent total hip arthroplasty; however, the GM was assessed during the THA, and it was verified that the repair was intact. There were no clinical failures, secondary operations, or complications. CONCLUSIONS Endoscopic repair of gluteus medius tears is a safe procedure with favorable and durable long-term outcomes at minimum 10-year follow-up. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- Benjamin G Domb
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A.; American Hip Institute, Chicago, Illinois, U.S.A..
| | - Jade S Owens
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - David R Maldonado
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - W Taylor Harris
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | | | - Payam W Sabetian
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
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Giai Via R, Elzeiny A, Bufalo M, Massè A, Giachino M. Endoscopic management of greater trochanteric pain syndrome (GTPS): a comprehensive systematic review. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024:10.1007/s00590-024-04019-0. [PMID: 38862847 DOI: 10.1007/s00590-024-04019-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 05/31/2024] [Indexed: 06/13/2024]
Abstract
BACKGROUND Greater trochanteric pain syndrome (GTPS) presents challenges in clinical management due to its chronic nature and uncertain etiology. Historically attributed to greater trochanteric bursitis, current understanding implicates abductor tendinopathy as the primary cause. Diagnosis usually involves a clinical examination and additional tests such as imaging and provocative testing. Surgical intervention may be considered for cases refractory to conservative therapy, with endoscopic techniques gaining ground over open procedures. MATERIALS AND METHODS A systematic review was conducted adhering to the PRISMA guidelines. Relevant studies were searched in four databases: Pubmed, Scopus, Embase, and Medline. The selected articles were evaluated according to the criteria of levels of evidence (LoE). The Coleman methodology score (mCMS) was used to analyze the retrospective studies. This systematic review was registered in the International Prospective Registry of Systematic Reviews. RESULTS Surgical success rates ranged from 70.6-100%, significantly improving pain and function. Complications were generally mild, mainly hematomas and seromas, while recurrence rates were low. However, limitations such as the retrospective design and the absence of control groups warrant cautious interpretation of the results. CONCLUSIONS Endoscopic surgery emerges as a promising option for refractory GTPS, offering effective symptom relief and functional improvement. Despite limitations, these results suggest a favorable risk-benefit profile for endoscopic procedures. Further research is needed, particularly prospective randomized trials, to confirm these findings and optimize surgical techniques to improve patient outcomes.
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Affiliation(s)
- Riccardo Giai Via
- Centro Traumatologico Ortopedico (CTO), Department of Orthopaedic Surgery, Department of Orthopaedic and Traumatology, University of Turin, Via Gianfranco Zuretti 29, 10126, Turin, Italy.
| | - Ahmed Elzeiny
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Kafr El Sheikh University, Kafr El Sheikh, Egypt
| | - Marco Bufalo
- Centro Traumatologico Ortopedico (CTO), Department of Orthopaedic Surgery, Department of Orthopaedic and Traumatology, University of Turin, Via Gianfranco Zuretti 29, 10126, Turin, Italy
| | - Alessandro Massè
- Centro Traumatologico Ortopedico (CTO), Department of Orthopaedic Surgery, Department of Orthopaedic and Traumatology, University of Turin, Via Gianfranco Zuretti 29, 10126, Turin, Italy
| | - Matteo Giachino
- Centro Traumatologico Ortopedico (CTO), Department of Orthopaedic Surgery, Department of Orthopaedic and Traumatology, University of Turin, Via Gianfranco Zuretti 29, 10126, Turin, Italy
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Axelrod DE, Ekhtiari S, Winemaker MJ, de Beer J, Wood TJ. Management of Greater Trochanteric Pain Syndrome After Total Hip Arthroplasty: Practice Patterns and Surgeon Attitudes. J Am Acad Orthop Surg Glob Res Rev 2023; 7:01979360-202312000-00005. [PMID: 38048139 PMCID: PMC10697621 DOI: 10.5435/jaaosglobal-d-23-00085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 09/11/2023] [Accepted: 09/23/2023] [Indexed: 12/05/2023]
Abstract
INTRODUCTION Greater trochanteric pain syndrome (GTPS) or trochanteric bursitis is described as pain on the lateral side of the hip that does not involve the hip joint and can be elicited clinically by palpation over the greater trochanter. To date, there remains no consensus on clinical guidelines for either diagnosis or management of GTPS. METHODS To understand the practice patterns, beliefs, and attitudes relating to the management of GTPS after total hip arthroplasty, a survey was developed and completed by Canadian arthroplasty surgeons. The final survey consisted of 23 questions divided into three sections: 1) screening questions; 2) demographic information; and 3) practice patterns, attitudes, and beliefs. RESULTS Most surgeons use physical examination alone for diagnosis. A detailed analysis indicates that surgeons primarily treat GTPS with oral anti-inflammatories (57.1%), structured physiotherapy (52.4%), and steroid injections (45.2%). Management options are typically nonsurgical and comprise a combination of either unstructured or targeted physiotherapy, corticosteroid injections, or platelet-rich plasma. DISCUSSION There remains an absence of clinical consensus for the diagnosis and management of GTPS after total hip arthroplasty. Physical examination is most often relied on, regardless of the availability of imaging aids. While common treatments of GTPS were identified, up to one-third of patients fail initial therapy.
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Affiliation(s)
- Daniel E. Axelrod
- From the Division of Orthopaedic Surgery, McMaster University, Hamilton, ON (Dr. Axelrod, Dr. Ekhtiari, Dr. Winemaker, and Dr. Wood), and the Hamilton Arthroplasty Group, Hamilton Health Sciences, Ontario, Canada (Dr. Winemaker and Dr. Wood)
| | - Seper Ekhtiari
- From the Division of Orthopaedic Surgery, McMaster University, Hamilton, ON (Dr. Axelrod, Dr. Ekhtiari, Dr. Winemaker, and Dr. Wood), and the Hamilton Arthroplasty Group, Hamilton Health Sciences, Ontario, Canada (Dr. Winemaker and Dr. Wood)
| | - Mitchell J. Winemaker
- From the Division of Orthopaedic Surgery, McMaster University, Hamilton, ON (Dr. Axelrod, Dr. Ekhtiari, Dr. Winemaker, and Dr. Wood), and the Hamilton Arthroplasty Group, Hamilton Health Sciences, Ontario, Canada (Dr. Winemaker and Dr. Wood)
| | - Justin de Beer
- From the Division of Orthopaedic Surgery, McMaster University, Hamilton, ON (Dr. Axelrod, Dr. Ekhtiari, Dr. Winemaker, and Dr. Wood), and the Hamilton Arthroplasty Group, Hamilton Health Sciences, Ontario, Canada (Dr. Winemaker and Dr. Wood)
| | - Thomas J. Wood
- From the Division of Orthopaedic Surgery, McMaster University, Hamilton, ON (Dr. Axelrod, Dr. Ekhtiari, Dr. Winemaker, and Dr. Wood), and the Hamilton Arthroplasty Group, Hamilton Health Sciences, Ontario, Canada (Dr. Winemaker and Dr. Wood)
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Lubowitz JH, Brand JC, Rossi MJ. Arthroscopy and Musculoskeletal Biologics. Arthroscopy 2023; 39:1113-1116. [PMID: 37019524 DOI: 10.1016/j.arthro.2023.01.096] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 01/27/2023] [Indexed: 04/07/2023]
Abstract
Orthopaedic biologics holds great promise. Absent peer-reviewed clinical musculoskeletal research, orthobiologics indications and treatment recommendations will remain opaque. In a Call for Papers, Arthroscopy; Arthroscopy Techniques; and Arthroscopy, Sports Medicine, and Rehabilitation editors invite authors to submit clinical musculoskeletal biologics original scientific research, and technical notes with video. Each year, the top articles will be awarded inclusion in an annual Biologics Special Issue. Future investigators and current readers could follow the science while being mindful of the regulatory environment.
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Quigley R, Frazier L, Cole BJ. Orthopaedic Musculoskeletal Biologics Research Impacts Patient Care: The First Annual Arthroscopy Orthobiologics Virtual Special Issue. Arthroscopy 2023; 39:1117-1118. [PMID: 37019525 DOI: 10.1016/j.arthro.2022.11.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 11/09/2022] [Indexed: 04/07/2023]
Abstract
Orthobiologics can modify symptoms and improve healing in a variety of musculoskeletal conditions as a part of office-based care or as an adjunct to surgery. Orthobiologics harness the benefits of naturally derived blood components, autologous tissue, and growth factors to reduce inflammation and optimize the host-healing environment. The Arthroscopy family of journals seeks to positively influence evidence-based clinical decision-making by publishing peer-reviewed biologics research. This special issue contains recent influential articles strategically chosen to positively impact patient care.
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Abid H, Foissey C, Haidar I, de Saint Vincent B, Thaunat M. Arthroscopic treatment of type I and II greater trochanteric pain syndrome. Orthop Traumatol Surg Res 2022; 108:103312. [PMID: 35568296 DOI: 10.1016/j.otsr.2022.103312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 09/23/2021] [Accepted: 01/04/2022] [Indexed: 02/03/2023]
Abstract
The goal of this study was to describe and evaluate endoscopic bursectomy combined with fascia lata lengthening in the treatment of type I and II greater trochanteric pain syndrome recalcitrant to conservative management. This was a retrospective study of 20 patients (7 type I, 13 type II) reviewed with a minimum follow-up of 2 years. The mean follow-up was 44±11 [26-65] months. While significant improvements in pain, mHHS and NAHS were found, 80% of patients still had hip pain graded at≥3 on VAS. The satisfaction rate was 7/10±2 [3-10]. Snapping in the hip had been eliminated in 100% of cases. No complications were observed. This is a minimally invasive surgery that is feasible in patients who have failed an optimal course of conservative treatment. But patients must be informed that pain might not be completely eliminated by this procedure. LEVEL OF EVIDENCE: IV; retrospective, case series.
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Affiliation(s)
- Hichem Abid
- Ramsay Santé, centre orthopédique Santy, hôpital privé Jean Mermoz, 24, avenue Paul-Santy, 69008 Lyon, France
| | - Constant Foissey
- Ramsay Santé, centre orthopédique Santy, hôpital privé Jean Mermoz, 24, avenue Paul-Santy, 69008 Lyon, France
| | - Ibrahim Haidar
- Ramsay Santé, centre orthopédique Santy, hôpital privé Jean Mermoz, 24, avenue Paul-Santy, 69008 Lyon, France
| | - Benoît de Saint Vincent
- Ramsay Santé, centre orthopédique Santy, hôpital privé Jean Mermoz, 24, avenue Paul-Santy, 69008 Lyon, France
| | - Mathieu Thaunat
- Ramsay Santé, centre orthopédique Santy, hôpital privé Jean Mermoz, 24, avenue Paul-Santy, 69008 Lyon, France.
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Maldonado DR, Youssefzadeh KA, Wydra F, Sherman B, Gerhardt MB. High Prevalence of Lumbosacral Pathology in Patients with Greater Trochanteric Pain Syndrome. Arthroscopy 2022; 38:1189-1192. [PMID: 34601010 DOI: 10.1016/j.arthro.2021.09.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 09/15/2021] [Accepted: 09/15/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To establish prevalence of lumbar and lumbosacral pathologies in patients with hip abductor tendon disorders. METHODS A retrospective review of patients' charts was conducted over a 5-year period, January 2013 to October 2018, using the S76 and M76 International Classification of Diseases Tenth Revision (ICD-10) codes. Patients with symptomatic and radiologically confirmed hip abductor tendon disorders (partial and full-thickness tear of the gluteus medius tear with or without gluteus minimus tearing) were included in the study. No exclusion criteria were applied. Patient medical history was examined for concurrent diagnoses of lumbar and lumbosacral pathologies (radiculopathy, lumbar stenosis, degenerative disc disease, and neurogenic claudication). RESULTS One-hundred and three patients with hip abductor tendon disorders were identified. Forty-seven (45.6%) patients had low-grade partial abductor tears, while 56 (54.4%) of patients had a high-grade partial or complete abductor tear. Fifty (48.5%) patients carried a concomitant lumbosacral diagnosis, with 20 (19.4%) patients being diagnosed with lumbar stenosis and 45 (43.7%) being diagnosed with degenerative disc disease. CONCLUSION Patients with hip abductor tendon disorders were associated with a high prevalence of underlying lumbar and lumbosacral pathologies. Nevertheless, a causal relationship between these conditions cannot be established. LEVEL OF EVIDENCE Level IV. Retrospective Case Series.
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Affiliation(s)
- David R Maldonado
- Cedars Sinai, Kerlan-Jobe Institute, Santa Monica Orthopaedic and Sports Medicine Group, Santa Monica, California, U.S.A
| | - Keon A Youssefzadeh
- Cedars Sinai, Kerlan-Jobe Institute, Santa Monica Orthopaedic and Sports Medicine Group, Santa Monica, California, U.S.A..
| | - Frank Wydra
- Cedars Sinai, Kerlan-Jobe Institute, Santa Monica Orthopaedic and Sports Medicine Group, Santa Monica, California, U.S.A
| | | | - Michael B Gerhardt
- Cedars Sinai, Kerlan-Jobe Institute, Santa Monica Orthopaedic and Sports Medicine Group, Santa Monica, California, U.S.A
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Weber P, Harrasser N, Twardy V, Gollwitzer H, Banke IJ. [Avulsion injuries of the gluteus medius and gluteus minimus muscles]. Unfallchirurg 2021; 124:526-535. [PMID: 34170360 DOI: 10.1007/s00113-021-01034-2] [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: 05/20/2021] [Indexed: 11/30/2022]
Abstract
Avulsion injuries of the gluteus medius and gluteus minimus muscles represent a diagnostic and therapeutic challenge. Such injuries are rarely to be expected in high-energy trauma. Degenerative damage or iatrogenic injuries in the context of hip surgery are more frequently identified as the cause. Clinically, in addition to lateral hip pain, limping is an important finding and depends on the extent of the tendon damage. In addition to the medical history and clinical examination, imaging by means of sonography and, above all, magnetic resonance imaging (MRI, possibly with artifact-reduced sequences in the presence of an endoprosthesis) are diagnostically groundbreaking. Therapeutically, a stepwise approach is indicated according to the extent of rupture and quality of the gluteal tendon and muscle tissues. Specific conservative training regimens, mini-open/endoscopic anatomic reconstruction techniques in cases of gluteal muscle integrity and muscle transfer techniques as salvage option with chronic mass ruptures are available. The common goal is the restoration of everyday occupational and private activities to regain the quality of life.
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Affiliation(s)
- P Weber
- ECOM Excellent Center of Medicine, Arabellastr. 17, 81925, München, Deutschland
| | - N Harrasser
- ECOM Excellent Center of Medicine, Arabellastr. 17, 81925, München, Deutschland.,Klinik und Poliklinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland.,MVZ ATOS, Effnerstr. 38, 81925, München, Deutschland
| | - V Twardy
- Klinik und Poliklinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
| | - H Gollwitzer
- ECOM Excellent Center of Medicine, Arabellastr. 17, 81925, München, Deutschland
| | - I J Banke
- Klinik und Poliklinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland.
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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. Eur Radiol 2021; 32:551-560. [PMID: 34146140 PMCID: PMC8660721 DOI: 10.1007/s00330-021-07997-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/22/2021] [Accepted: 04/12/2021] [Indexed: 12/01/2022]
Abstract
Objectives Image-guided musculoskeletal interventional procedures around the hip are widely used in daily clinical practice. The need for clarity concerning the actual added value of imaging guidance and types of medications to be offered led the Ultrasound and the Interventional Subcommittees of the European Society of Musculoskeletal Radiology (ESSR) to promote, with the support of its Research Committee, a collaborative project to review the published literature on image-guided musculoskeletal interventional procedures in the lower limb in order to derive a list of clinical indications. Methods In this article, we report the results of a Delphi-based consensus of 53 experts who reviewed the published literature for evidence on image-guided interventional procedures offered in the joint and soft tissues around the hip in order of their clinical indications. Results Ten statements concerning image-guided treatment procedures around the hip have been collected by the panel of ESSR experts. Conclusions This work highlighted that there is still low evidence in the existing literature on some of these interventional procedures. Further large prospective randomized trials are essential to better confirm the benefits and objectively clarify the role of imaging to guide musculoskeletal interventional procedures around the hip. Key Points • Expert consensus produced a list of 10 evidence-based statements on clinical indications of image-guided interventional procedures around the hip. • The highest level of evidence was only reached for one statement. • Strong consensus was obtained for all statements. Supplementary Information The online version contains supplementary material available at 10.1007/s00330-021-07997-5.
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Kruel AVS, Ribeiro LL, Gusmão PD, Huber SC, Lana JFSD. Orthobiologics in the treatment of hip disorders. World J Stem Cells 2021; 13:304-316. [PMID: 33959220 PMCID: PMC8080542 DOI: 10.4252/wjsc.v13.i4.304] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 12/26/2020] [Accepted: 02/25/2021] [Indexed: 02/06/2023] Open
Abstract
Orthobiologics are biological materials that are intended for the regeneration or healing of bone, cartilage and soft tissues. In this review we discuss the use of orthobiologics for hip disorders providing an update. The orthobiologics included in this article are hyaluronic acid, platelet rich plasma, bone marrow, adipose tissue and expanded mesenchymal stem cells. We explain the concepts and definitions of each orthobiological product, and the literature regarding its use in the hip joint. The paucity of guidelines for the production and characterization of the biological products leads to uneven results across the literature. Each biologic therapy has indications and benefits; however, noteworthy are the characterization of the orthobiologics, the application method and outcome analysis for further improvement of each technique.
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Affiliation(s)
| | - Lucas Leite Ribeiro
- Department of Orthopedics, Instituto Médico Salus, São Paulo, SP 01308-050, Brazil
| | - Paulo David Gusmão
- Department of Orthopedics, the Bone and Cartilage Institute, Porto Alegre, RS 90570-020, Brazil
| | - Stephany Cares Huber
- Department of Hematology, University of Campinas, Campinas, SP 13334-170, Brazil
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Abstract
Biologics are a growing field that has shown immense promise for the treatment of musculoskeletal conditions both in orthopedic sports medicine and interventional pain management. These procedures utilize injection of supraphysiologic levels of platelets and growth factors to invoke the body's own inflammatory cascade to augment the healing of many bony and soft tissue conditions. While many patients improve with conservative care, there is a need to address the gap between those that improve with rehabilitation alone and those who ultimately require operative management. Orthobiologic procedures have the potential to fill this void. The purpose of this review is to summarize the basic science, evidence for use, and post-injection rehabilitation concepts of platelet-rich plasma (PRP) and mesenchymal stromal cells (MSCs) as they pertain to joints, tendons, ligaments, and the spine.
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Affiliation(s)
- Robert L Bowers
- Department of Physical Medicine and Rehabilitation, Emory University School of Medicine, Atlanta, GA; Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA.
| | - Wesley D Troyer
- Department of Physical Medicine and Rehabilitation, Emory University School of Medicine, Atlanta, GA; Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA
| | - Rudolph A Mason
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA; Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, GA
| | - Kenneth R Mautner
- Department of Physical Medicine and Rehabilitation, Emory University School of Medicine, Atlanta, GA; Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA
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Abstract
Gluteal insufficiency or hip abductor mechanism deficiency mainly following (revision) total hip replacement is associated with highly painful complaints and severe suffering of patients. It represents a great diagnostic and therapeutic challenge. Differentiated conservative treatment pathways, open surgical and endoscopic anatomic repair techniques with intact gluteal musculature and muscle transfer are available as salvage procedures for chronic not anatomically reconstructable mass ruptures. A stepwise diagnostic and therapeutic approach is required for restoration of the quality of life and painless or almost painless mobility of affected patients in occupation and daily life.
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Editorial Commentary: Platelet-Rich Plasma Versus Surgery for Hip Greater Trochanteric Pain Syndrome-Systematic Reviews Made Difficult by the Use of Vague Terms. Arthroscopy 2020; 36:889-890. [PMID: 32139065 DOI: 10.1016/j.arthro.2019.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Accepted: 12/28/2019] [Indexed: 02/02/2023]
Abstract
Greater trochanteric pain syndrome responds favorably to platelet-rich plasma and surgery as measured by patient-reported outcomes, with a lesser complication rate with injections. Broad and inaccurate terminology makes data synthesis impossible and systematic reviews difficult to interpret.
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