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SURGICAL REPAIR OF THE ABDUCTOR MECHANISM OF THE HIP



Abstract

Lateral hip pain is a common problem in middle-aged females. After investigation, a group of patients remain who are given the diagnosis of ‘trochanteric bursitis’. Treatment to date has included physiotherapy, non-steroidal anti inflammatory medication and judicious use of a combined corticosteroid and local anaesthetic preparation injected into the bursa with or without imaging control. Some surgical procedures have been described. The aims of this study are to document and describe our experience with 88 patients and to raise awareness of the condition as a common cause of lateral hip pain which is amenable to surgical repair.

This study has the approval of the Western Sydney area health service. Between 2000 and 2008, 161 patients were referred to the senior author for management of lateral hip pain. 121 patients underwent surgery to repair a gluteal tendon detachment. 32 patients were excluded from the study due to concurrent or previous surgery to the area. A surgical audit was performed on the remaining 88 patients.

Assessment was performed using the Merle d’Aubigne and Postel scoring system. The average duration of symptoms was 6 – 144 months. At 6 months, 88% patients had minimal or no pain. There were also significant improvements in range of motion and ability to walk. The most significant complication was deep vein thrombosis (6%).

Based on our experience, any patient who does not respond to treatment for trochanteric bursitis should be investigated for a gluteal tendon tear. Those with a positive MRI scan of the trochanteric region can be offered surgery for gluteal tendon repair.

Correspondence should be addressed to Editorial Secretary Mr ML Costa or Assistant Editorial Secretary Mr B.J. Ollivere at BOA, 35–43 Lincoln’s Inn Fields, London WC2A 3PE, England; Email: mattcosta@hotmail.com or ben@ollivere.co.uk