Introduction. Background: Trochanteric bursitis is a common and poorly understood complication following total hip arthroplasty (THA). The purpose of this study was to evaluate the incidence of symptomatic trochanteric bursitis and the change in hip offset among THA patients before and after the introduction of robotic assistance. Methods. Retrospective chart review of THAs performed by a single over a 3-year period between 1/5/2013 and 6/28/2016. Between 1/5/2013 and 11/11/2014 101 consecutive patients were identified that underwent manual posterior-lateral THA that utilized traditional cup positioning method based on AP Pelvis radiograph. The subsequent six-month period during a complete transition to robotic arm assistance for posterior-lateral THA was excluded to eliminate any learning curve or selection bias. Between 6/2015 and 6/2016 109 consecutive patients that underwent robotic arm-assisted. Medical records were reviewed for symptomatic trochanteric bursitis within two years of surgery. Hip offset was measured on preoperative and postoperative AP pelvis radiographs and postoperative joint reactive forces were calculated using Martell's Hip Analysis Suite. Results. The rate of symptomatic trochanteric bursitis was 21% in the manual THA population and 10.4% in the population of THAs performed with robotic assistance (P=0.02). The post-operative change in hip offset was significantly higher in patients undergoing traditional THA than patients undergoing robotic arm-assisted THA (5.95 mm vs 4.40 mm; p = 0.0071). Discussion/Conclusion. Transition to robotic arm-assisted THA was associated with decreased incidence of symptomatic trochanteric bursitis and a decreased post-operative change in hip offset

Glutamate regulates the expression of apoptosis-related genes and triggers the apoptosis of fibroblasts in rotator cuff tendons. Subacromial bursitis is always accompanied by symptomatic rotator cuff tear (RCT). However, no study has been reported on the presence of glutamate in subacromial bursa and on its involvement of shoulder pain in patients who had RCT. The purposes of this study were to determine whether the glutamate expression in subacromial bursa is associated with the presence of RCT and with the severity of shoulder pain accompanying RCT. Subacromial bursal tissues were harvested from patients who underwent arthroscopic rotator cuff tendon repair or glenoid labral repair with intact rotator cuff tendon. Glutamate tissue concentrations were measured, using a glutamate assay kit. Expressions of glutamate and its receptors in subacromial bursae were histologically determined. The sizes of RCT were determined by arthroscopic findings, using the DeOrio and Cofield classification. The severity of shoulder pain was determined, using visual analog scale (VAS). Any associations between glutamate concentrations and the size of RCT were evaluated, using logistic regression analysis. The correlation between glutamate concentrations and the severity of pain was determined, using the Pearson correlation coefficient. Differences with a probability <0.05 were considered statistically significant. Glutamate concentrations showed significant differences between the torn tendon group and the intact tendon group (P = 0.009). Concentrations of glutamate significantly increased according to increases in tear size (P < 0.001). In histological studies, the expressions of glutamate and of its ionotropic and metabotropic receptors have been confirmed in subacromial bursa. Glutamate concentrations were significantly correlated with pain on VAS (Rho=0.56 and P =0.01). The expression of glutamate in subacromial bursa is significantly associated with the presence of RCT and significantly correlated with its accompanying shoulder pain. Acknowledgements: This research was supported by the Basic Science Research Program, through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (NRF-2015R1D1A3A01018955 and 2017R1D1A1B03035232)

Objectives. Sacroiliac joint dysfunction is a degenerative condition that can result in low back pain and is likely underdiagnosed. Diagnosis is made clinically with the patient experiencing pain in the sacroiliac joint region. Initial management is non-operative with pain management, physiotherapy, injections, and rhizolysis. If these fail then surgical management, by sacroiliac joint fusion, can be considered. The aim of this study was to review the outcomes of all patients who underwent sacroiliac joint fusion by a single surgeon in a large district general hospital between April 2018 and April 2023. Design and Methods. A retrospective review of all patients who underwent sacroiliac joint fusion between April 2018 and April 2023 was conducted. Data was collected from clinical letters, operative notes, and the British Spinal Registry. Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS) for back and leg pain were recorded as well as any post-operative complications. Results. In total 19 patients underwent sacroiliac joint fusion. Mean age was 47 years (range 27 – 69 years). Nine were right sided procedures and ten were left. The mean BMI was 32.3. ODI improved from a mean of 55 pre-operative to 26 at one year and 15 at two years post-operative. VAS for back pain improved from a mean of six pre-operative to three at one year and one at two years post-operative. VAS for leg pain improved from a mean of five pre-operative to four at one year and zero at two years post-operative. There were no surgical site complications. One patient developed trochanteric bursitis post-operatively. Two patients have since undergone sacroiliac joint fusion on the contralateral side with a further patient awaiting contralateral surgery. Conclusion. In patients with sacroiliac joint pain where non-operative measures have failed to control symptoms sacroiliac joint fusion is a reliable and effective surgical option

Modular dual mobility (DM) articulations are increasingly utilized during total hip arthroplasty (THA). However, concerns remain regarding the metal liner modularity. This study aims to correlate metal artifact reduction sequence (MARS) magnetic resonance imaging (MRI) abnormalities with serum metal ion levels in patients with DM articulations. All patients with an asymptomatic, primary THA and DM articulation with >2-year follow-up underwent MARS-MRI of the operative hip. Each patient had serum cobalt, chromium, and titanium levels drawn. Patient satisfaction, Oxford Hip Score, and Forgotten Joint Score-12 (FJS-12) were collected. Each MARS-MRI was independently reviewed by fellowship-trained musculoskeletal radiologists blinded to serum ion levels. Forty-five patients (50 hips) with a modular DM articulation were included with average follow-up of 3.7±1.2 years. Two patients (4.4%) had abnormal periprosthetic fluid collections on MARS-MRI with cobalt levels >3.0 μg/L. Four patients (8.9%) had MARS-MRI findings consistent with greater trochanteric bursitis, all with cobalt levels < 1.0 μg/L. A seventh patient had a periprosthetic fluid collection with normal ion levels. Of the 38 patients without MARS-MRI abnormalities, 37 (97.4%) had cobalt levels <1.0 μg/L, while one (2.6%) had a cobalt level of 1.4 μg/L. One patient (2.2%) had a chromium level >3.0 μg/L and a periprosthetic fluid collection. Of the 41 patients with titanium levels, five (12.2%) had titanium levels >5.0 μg/L without associated MARS-MRI abnormalities. Periprosthetic fluid collections associated with elevated serum cobalt levels in patients with asymptomatic dual mobility articulations occur infrequently (4.4%), but further assessment of these patients is necessary. Level of Evidence: Level IV

Aim. Antibiotic concentration at the infected site is a relevant information to gain knowledge about deep-seated infections. The combination of antibiotic therapy and debridement is often indicated to treat these infections. At University Hospital Basel the most frequently administered antibiotic before debridement is amoxicillin in combination with clavulanic acid. Amoxicillin is a fragile beta-lactam antibiotic that brings multiple challenges for its quantification. As for many sample materials only little material is available, the aim of this work was to establish a sensitive and reliable quantification method for amoxicillin that only requires a small sample mass. We did not quantify clavulanic acid as we focused on the drug with antibiotic action. Method. Usually discarded sample material during debridement was collected and directly frozen. The thawed tissues were prepared using simple protein precipitation and manual homogenization with micro pestles followed by a matrix cleanup with online solid-phase extraction. Separation was performed by HPLC followed by heated electrospray ionization and tandem mass spectrometry. Results. During method development, amoxicillin showed partial formation of a covalent methanol adduct when performing protein precipitation. Furthermore, multiple in-source products of amoxicillin during ionization could be observed. Adding an aqueous buffer to the samples before protein precipitation and summing up the signals of amoxicillin and its in-source acetonitrile-sodium-adduct led to successful method validation for a calibration range of 1–51 mg/kg using 10 mg of each tissue sample. The imprecision was < 8% over the entire concentration range and the bias was ≤ 10 %. The quantitative matrix effect was < 6 % in six different tissue samples. Until now we measured amoxicillin in samples from nine patients with prosthetic joint infection, bursitis, or an abscess who obtained amoxicillin between 5 hours and 15 minutes before sampling and found concentrations between 1.4 and 35 mg/kg. Conclusions. With this method, we developed a fast, simple, and sensitive quantification assay for amoxicillin in tissue samples with little material that can now be applied to different study samples

The prevalence of gluteal tendinopathy (GT) associated with osteoarthritis of the hip is difficult to determine as it is frequently undiagnosed or misdiagnosed as trochanteric bursitis. Its relationship to total hip arthroplasty (THA) outcomes is currently unknown. The aim of this study was to determine the incidence of GT at the time of hip arthroplasty and examine the relationship between GT and patient reported outcomes (PROMS) before and after THA. Patients undergoing THA for primary osteoarthritis between August 2017 and August 2020 were recruited. Tendinopathy was assessed and graded at time of surgery. PROMS included the Oxford Hip Score (OHS), HOOS JR, EQ-5D, and were collected preoperatively and at one year after THA. Satisfaction with surgery was also assessed at 1 year. 797 patients met eligibility criteria and were graded as Grade 1: normal tendons (n =496, 62%), Grade 2: gluteal tendinopathy but no tear (n=222, 28%), Grade 3: partial/full thickness tears or bare trochanter (n=79, 10%). Patients with abnormal gluteal tendons were older (p=0.001), had a higher mean BMI (p=0.01), and were predominately female (p=0.001). Patients with higher grade tendinopathy had statistically significant inferior PROMS at one year, OHS score (44.1 v 42.9 v 41.3, p 0.001) HOOS JR (89.3 V 86.3 V 85.6 p 0.005). Increasing gluteal tendon grade was associated with a greater incidence of problems with mobility (p=0.001), usual activities (p=0.001) and pain (p=0.021) on EQ5D. There was a 3 times relative risk of overall dissatisfaction with THA in the presence of gluteal tears. This study demonstrated that gluteal tendinopathy was commonly observed and associated with inferior 1-year PROMS in patients undergoing THA for OA. Increasing degree of tendinopathy was a negative prognostic factor for worse functional outcomes and patient satisfaction

Aim. The optimal surgical approach for patients hospitalized for moderate to severe septic bursitis is not known, and there have been no randomized trials of a one-stage compared with a two-stage (i.e., bursectomy, followed by closure in a second procedure) approach. Thus, we performed a prospective, non-blinded, randomized study of adult patients hospitalized for an open bursectomy. Method. Patients were randomized 1:1 to a one-stage vs. a two-stage surgical approach. All patients received postsurgical oral antibiotic therapy for 7 days. These are the final results of the prospective study registered at ClinicalTrials (NCT01406652). Results. Among 164 enrolled patients, 130 had bursitis of the elbow and 34 of the patella. The surgical approach used was one-stage in 79 and two-stage in 85. The two groups were balanced with regards to sex, age, causative pathogens, levels of serum inflammatory markers, co-morbidities, and cause of bursitis. Overall, there were 22 treatment failures: 8/79 (10%) in the one-stage arm and 14/85 (16%) in the two-stage arm (Pearson-χ2-test; p=0.23). Recurrent infection was caused by the same pathogen a total of 7 patients (4%), and by a different pathogen in 5 episodes (3%). The incidence of infection recurrence was not significantly different between those in the one- vs. two-stage arms (6/79 vs. 8/85; χ2-test: p=0.68). In contrast, outcomes were better in the one- vs. two-stage arm for wound dehiscence (2/79[3%] vs. 10/85[12%]; p=0.02), median length of hospital stay (4.5 vs. 6 days), nurses’ workload (605 vs. 1055 points) and total costs (6,881 vs. 11,178 Swiss francs) (all p<0.01). Conclusions. For adult patients with moderate to severe septic bursitis requiring hospital admission, bursectomy with primary closure, together with 7 days of systemic antibiotic therapy, was safe, resource-saving and effective. Using a two-stage approach did not reduce the risk of infectious recurrence, and may be associated with a higher rate of wound dehiscence than the one-stage approach

Primary tuberculous bursitis was a relatively frequent manifestation of the disease before the antituberculosis drug era. Nowadays, it is considered a rare condition; it accounts for 1–2% of all musculoskeletal tuberculosis. The diagnosis and treatment of tuberculous bursitis may be delayed because the paucity of symptoms, its indolent clinical course and a low clinical suspicion. A 50-year-old patient with tuberculous trochanteric bursitis is reported. A 50-year-old woman was referred to our department to investigate a persistent pain in her left hip with 6 months duration. She was afebrile. The examination revealed a diffuse swelling from the buttock through the thigh, notable over the trochanter, but no sign of acute inflammation such as heat and redness. Her past medical and family histories revealed no previous tuberculosis. Plain films of the left hip showed a partial destruction of the margin of the greater trochanter, lytic foci in the underlying bone and a small focus of calcification in the adjacent soft tissues. A computed tomogram showed a soft tissue mass and demonstrated the relationship with the trochanter. We performed a needle biopsy which revealed granulomatous tissue. The patient underwent complete excision of the bursa and curettage of the surface of the trochanter. The postoperative course was uneventful. Mycobacterium tuberculosis was isolated and definitive diagnosis of tuberculous bursitis was made. There was no evidence of concomitant tuberculosis at other musculoskeletal sites. The patient completed a treatment with rifampicin and etambutol for 6 months. There has been a complete resolution of the symptoms after 3 months and no recurrence after 4 years of follow-up. On plain radiograph the remodeling of the bone structure is clearly visible. Tuberculosis in the region of the greater trochanter is extremely rare. This rarity leads orthopedic surgeons to neglect this potential diagnosis, resulting in a delay in treatment. The pathogenesis of tuberculosis of the greater trochanteric area has not been well defined. The incidence of concomitant tuberculosis at other musculoskeletal sites, as well as the lung, is approximately 50%. Both hematogenous infection and propagation from other locations are reasonable explanations. Surgical intervention is mandatory for cure and the use of several antituberculosis agents is a standard approach

Introduction: Trochanteric bursitis is a common hip problem that can be refractory to treatment. The available modalities of treatment can be less effective. We evaluated the use of extra-corporeal shockwave therapy treatment for trochanteric bursitis. Methodology: 22 patients with the clinical and radiological (in 6 patients) diagnosis of trochanteric bursitis were treated in a dedicated shockwave therapy clinic using Swiss dolocast radial shockwave therapy machine. 3 sessions of treatment were given one week apart, delivering 2000 impulses at 10 Hz at each session. Patients were evaluated prior to treatment, 3 months, 6 months and 12 months following their treatment. The visual analogue score (VAS) was used in all patients pre and post treatment. Hip disability and osteoarthritis score (HOOS) was performed post-treatment. Results: Between December 2005 and November 2008 22 patients were treated for symptoms of trochanteric bursitis. There were 17 women and 5 men. The average age was 55.8 years (range 33–76 years). 6 patients had proven increase signal on MRI scan the rest were mainly clinical diagnosis and after a limited response to steroid injections. Their VAS improved from 10 to 5. Their post-treatment HOOS score averaged 255. Of the 6 patients who had MRI proven increased signal 5 patients had significant improvement. The average improvement in the VAS was 10 to 2.3 and their HOOS scores were 349.2 (range 427–243). Conclusion: Though the number of patients in this study is only 22 it seems that radial shockwave therapy treatment for trochanteric bursitis is promising, especially on those who have got high signal on MRI scans

Trochanteric bursitis is initially treated with local anaesthetic and corticosteroid injections but when this fails there are few interventions that relieve the symptoms. We report a new surgical technique for refractory trochanteric bursitis in 43 patients. Fourteen patients had developed trochanteric bursitis after primary total hip arthroplasty (THA), 6 after revision THA, 17 for no definable reason (idiopathic) and 7 after trauma. Follow up ranged from six months to 15 years (mean five years). Outcome was measured by pre and post operative Oxford Hip Scores. The mean post operative decreases were 23 points in traumatic cases, 13 in idiopathic and 13 for patients after primary THA. A mean increase of 3 was observed in patients after revision THA. The operation relieved symptoms in 75%. The outcome depended on aetiology. 100% of traumatic, 88% of idiopathic and 64% after primary THA were successful. All operations after revision THA were unsuccessful. This is the largest series of a single surgical technique for refractory trochanteric bursitis and the only one to subdivide the outcome by aetiology. Transposition of the gluteal fascia is indicated in patients with idiopathic, traumatic and post primary THA trochanteric bursitis, but not after revision THA

Introduction. Trochanteric bursitis is described as pain over the lateral side of the hip and thigh. The usual treatment is rest, administration of NSAIDs and injection of local anaesthetic and corticosteroid. Occasionally it is resistant to these measures. Background. Whilst performing an ablation of the trochanteric bursa we noticed that the fascia lata looked particularly tight. Therefore a z-plasty of the fascia lata was performed. Methods. Patients were identified from the senior author's logbook. Retrospective case note review and telephone interview study was performed. All patients who have undergone this procedure between October 2004 and September 2006 are included. They had all failed a regime of 8/52 physiotherapy and NSAID followed by x3 injections 8/52 apart. The visual analogue pain scoring system was used to assess all the patients post-operatively. Complete resolution of pain was seen as an excellent result. A score of 1-2 was regarded as good, and 3 or above as poor. All were followed up in the outpatients until they had returned to normal function. Results. We present 15 patients with a mean follow-up of 14 (4-27) months. Mean age 50 (18-76). 10 were women. All were unilateral. 13 excellent and 2 good results. All returned to normal function. There was 1 superficial infection. No patients had a snapping IT band. Discussion. Trochanteric bursitis is a common condition with an incidence in primary care of as 1.8 patients per 1000 per year. It is more common in females (80%). Trochanteric bursitis is commonly due to repetitive trauma with repetitive irritation of the bursa by the fascia lata during walking. Therefore by elongating the fascia lata slightly you can prevent this repetitive trauma. Conclusion. Z-plasty of the fascia lata is a procedure that can be used for the treatment of intractable trochanteric bursitis

31 patients, between the ages of 59 and 74 years, were referred to one onrthopaedic consultant as trochanteric bursitis. All were females. Of these 7 patients were diagnosed as osteoarthritis of the hip or underwent further investigations for spinal conditions. 24 patients were clinically diagnosed as trochanteric bursitis. All these patients had ultrasound examination of the hips by a radiologist with a special interest in musculoskeletal diseases. Except for one patient the rest had either gluteus medius inflammation or tears with or without involvement of gluteus minimus. All these patients with positive findings had 80mg of depomedrone injection under USG guidance. At 6 weeks follow up 21 had complete relief of symptoms. 4 had recurrence of symptoms at 3 months when they had another dose of depomedrone und USG guidance. At one year 18 were free of symptoms and the 3 with some recurrence of symptoms did not want any intervention. Discussion: Etiology of greater trochanteric pain syndrome has been a source of considerable debate. Empirical treatment with ‘blind’ steroid injection is the usual course of action. In unresolving trochanteric bursitis excision of trochanteric bursa has been advocated. Gluteus medius and minimus tears have been referred to as rotator cuff tears of the hip (1). Our study shows an association between trochanteric bursitis and ‘rotator cuff tears of hip’. Ultrasound guided steroid injection can give a better success rate of ‘hitting the right spot’. Further investigations are required to identify whether this association could be a cause and effect relationship

Purpose. Chemokines produced by synoviocytes of the subacromial bursa are up-regulated in subacromial inflammation (bursitis) and rotator cuff disease. SDF-1a is an important chemotactic factor in the subacromial bursa that stimulates recruitment of inflammatory cells; however, its mechanism of induction and regulation in the subacromial bursa is unknown. We hypothesised that SDF-1a production in bursal synoviocytes may be induced by local cytokines such as interleukin IL-1β and IL-6. Methods. Subacromial bursa specimens were obtained following an institutional review board-approved protocol from patients undergoing shoulder surgery. Bursal specimens were stained with anti-human antibodies to IL-1, IL-6 and SDF-1a by immunohistochemistry and compared to normal and rheumatoid controls. Bursal cells were also isolated from specimens and cultured. Cultured cells were labelled with fluorescent probes and analysed by flow cytometry to determine cell lineage. Early-passaged cells were then treated with cytokines IL-1β and IL-6 and SDF-1a production and expression were measured by ELISA and RT-PCR. Results. SDF-1a, IL-1β and IL-6 were expressed at high levels in bursitis specimens from human subacromial bursa compared to normal controls. In bursal synoviocytes, there was a dose-dependent increase in SDF-1a production in the supernatants of cells treated with IL-1β. SDF-1a mRNA expression was also increased in bursal cells treated with IL-1β, with stimulation occurring at 6 hours and increasing to five-fold stimulation by 48 hours. IL-6 caused a minimal but not statistically significant increase in SDF-1a expression. Conclusion. SDF-1a, IL-1β, and IL-6 are expressed in the inflamed human subacromial bursal tissues in patients with subacromial bursitis. In cultured bursal synoviocytes, SDF-1a production is stimulated by IL-1β. These cytokines may stimulate or potentiate the inflammatory response that occurs in subacromial bursitis and rotator cuff disease, and may provide a potential new target mechanism for inhibition of this common clinical problem

Introduction: The red, hot swollen knee is commonly seen in the A& E department and can present a diagnostic dilemma for the casualty officer. While superficial cellulites and bursitis are the most common diagnoses, anxiety is induced by the spectre of septic arthritis. The potential sequalae from aspirating a knee through infected superficial tissues further emphasise the importance of making an accurate clinical diagnosis. The lymph drainage of the superficial tissues of the lower limb is via lymphatics that accompany the long saphenous vein and drain to the lower group of the superficial inguinal nodes. Drainage from the knee joint is to a popliteal node situated between the knee joint capsule and the popliteal artery. Efferents from this node ascend in close relation to the femoral vessels and drains to the deep inguinal nodes. We hypothesise that the differences in lymphatic drainage mean that palpable inguinal nodes are more likely with superficial infections than with septic arthritis. We reviewed the clinical findings in a group of patients with superficial or deep infections to test this theory. Patients and Methods: From January 1995 until June 2000, twenty-seven patients were admitted with septic arthritis of the knee and fifty-one with superficial cellulites or bursitis about the knee. The former were diagnosed on the basis of clinical findings and a knee aspirate, the latter on clinical findings and response to treatment. The presence or absence of palpable inguinal lymph nodes was determined and compared for each diagnostic group. Results: Joint aspirates from the group with septic arthritis grew organisms in twenty patients (staph aureus in 19, strep pneumoniae in one). The remaining seven patients had no growth but purulent fluid on aspirate with leukocyte counts in excess of 50,000/mm. 3. Six patients had rheumatoid arthritis and two were HIV positive IVDA’s but the rest had no pre-disposing factors. The average age was 52 (range 16–83). All were treated with arthroscopic washout (average 2.2/patient) and antibiotic chemotherapy. In the superficial infection group 28 (56%) had pre-patellar bursitis and 23 (54%) cellulites. All were treated with antibiotics while eight of the bursitis group required incision and drainage. In the patients with superficial infection 32 (63%) had palpable inguinal lymphadenopathy while no patient with septic arthritis of the knee had palpably enlarged inguinal lymph nodes. This result is highly statistically significant (p< 0.01). Discussion: It is well recognised that neoplastic or inflammatory conditions of the superficial tissues of the lower limb may be associated with inguinal lymphadenopathy. A similar association for septic arthritis of the knee has not to our knowledge been described. Our study would suggest that palpably enlarged lymph nodes are unusual in this condition. While it is worth emphasizing that the presence of lymph nodes does not rule out absolutely the possibility of septic arthritis, their presence or absence may be useful in differentiating superficial from deep infections about the knee

The aim of this study was to evaluate the time of return to play of elite basketball and voleyball players (both grouped together as jumper) with Haglund deformity after surgical resection of the prominence in the postero-superolateral aspect of the calcaneum. Haglund deformity is a prominence in the postero superolateral aspect of the calcaneum, causing a painful bursitis, which may be difficult to treat by non-operative techniques. In this study, we evaluated the duration that is needed to reach a level that a player perform regularly in a competition. This study consists of players operated by the same surgeon with same technique from 2011 to 2019. Twenty eight feet of 22 patients underwent resection of Haglund deformity with lateral approach and the outcome was analysed using AOFAS Ankle-Hind Foot Scale for hindfoot and time to restart a full range regular training was reported. All players received one dose (5–6 cc) platelet rich fibrin to attachement site of Achilles tendon peroperatively just after decompression of prominence. The mean AOFAS score at the follow up was 90/100, at the end of first year and the majority of players returned to play at 4th to 8th month of follow-up. Only two players with deformity of three feet could start to perform after one year. We conclude that minimal invasive approach ostectomy is an effective treatment for players suffering from Haglund deformity and the results were from good to excellent. However, the player should be well informed that the recovery and returning to play can take a longer time than they expect

We describe a previously unreported technique of Z-lengthening for the treatment of refractory trochanteric bursitis and review the long-term outcomes for this procedure. Fifteen patients (17 hips) were diagnosed with trochanteric bursitis based on clinical criteria. These patients were found to be unresponsive to conservative treatment including multiple corticosteroids injections. “Snapping Hips” were excluded. All went on to have bursectomy and Z- lengthening of the iliotibial band. Harris Hip Scores were evaluated for before and after their operation as well as a standardised baseline questionnaire and examination. At mean follow up of 47 months following Z-lengthening, eight patients reported excellent results with complete resolution of symptoms, eight had good results with symptoms improved and one had a poor result. One patient required secondary repair of a tear in the tendon of gluteus minimus with a subsequent excellent result. The mean Harris Hip Score improved from 46 to 82 (p< 0.05). Bursectomy and Z-lengthening has been shown to be an effective and long-term operative solution for the treatment of refractory trochanteric bursitis when conservative measures have failed. Although the majority of patients had a successful outcome, not all respond well to this procedure and careful patient selection is recommended as well as a pre-operative MRI to rule out concomitant pathology such as a tear in the Gluteus medius or Gluteus minimus

Introduction: Trochanteric bursitis (TB) in association with increased femoral offset components in THA has not previously been reported. We report 15 cases of postoperative TB, all of whom were noted to have high offset femoral implants. Increasing awareness of this complication when inserting femoral components is an important consideration for the arthroplasty surgeon, emphasizing the need for preoperative templating. Methods: We retrospectively reviewed casenotes and postoperative radiographs patients attending outpatients following THA, with lateral hip pain. A diagnosis of trochanteric bursitis was made in individuals complaining of lateral hip pain, worse on exercising, and tenderness over the trochanter. The presence of a high offset femoral component was noted from casenotes radiographs. Patients with pre-existing TB, recent local trauma, or inflammatory disease which may contribute to TB, were excluded. Results: 15 cases were identified in a 3 year period. Female to male ratio 1.3:1. The mean age was 68 yrs with a range of 54–81yrs. 7/15 cases (46%) underwent posterior approach to the hip, 8/15 (54%) underwent a Hardinge lateral or modified lateral approach. All patients had clinical features of TB at first postoperative follow up. Mean time to onset of symptoms was 7.2 months, range 2–12 months. All femoral implants had 5mm offset or greater. Postoperative X-rays showed a mean increase in offset of 10.2mm, range 3–18mm. Discussion: The results indicate that an increase in femoral offset may increase a patient’s risk of trochanteric bursitis, following THA. The data suggest the operating surgeon should consider carefully the use of increased-offset implants, particularly in those at a higher risk or TB e.g inflammatory disorders. This study emphasises the importance of preoperative templating in total hip arthroplasty

This study describes a safe endoscopic technique for decompression of trochanteric bursa and presents the results of this procedure. Fifteen patients who had failed non-operative treatment for trochanteric bursitis were treated by endoscopic lengthening of fascia lata (FL) and trochanteric bursectomy. Two patients had also failed open decompressions performed at another institution prior to their endoscopic surgery. All patients took part in questionnaires pre-operatively and at three months and twelve months. A two-portal endoscopic procedure was performed in all subjects. A Cruciate incision was made in the FL hence lengthening it in three dimensions. A trochanteric bursectomy was then performed using a mechanical shaver. No patients were lost to follow up. At last review 14 patients rated their result as excellent and one patient had a fair result. There were no complications. The modified Harris hip score improved from 45 to 60, Non-arthritic hip score improved from 45 to 64 and SF12 score improved from 31 to 34. Endoscopic lengthening of FL and trochanteric bursectomy is a safe and effective procedure in relieving the symptoms of persistent trochanteric bursitis

Total hip arthroplasty (THA) is one of the most successful and commonly performed surgical interventions worldwide. Based on registry data, at one-year post THA, implant survivorship is nearly 100% and patient satisfaction is 90%. A novel, porous coated acetabular implant was introduced in Europe and Australia in 2007. Several years after its introduction, warnings were issued for the system when used with metal-on-metal bearings due to adverse local tissue reaction, with one study reporting a 24% failure rate (Dramis et al. 2014). A subsequent 2018 study by Teoh et al. showed that the acetabular system had a survival rate of 98.9% at five years when used with conventional polyethylene or ceramic bearing surfaces. The current study was conducted to determine the safety and effectiveness of the acetabular system using standard highly-crosslinked polyethylene (XLPE) and ceramic liners at five-year follow-up. Our hypothesis was that the acetabular system would exhibit survivorship comparable to other acetabular components on the market at five-year follow-up. A prospective, non-randomized study was conducted from February 2009 to June 2017 at eight sites in Canada and the USA. One hundred fifty-five hips were enrolled and 148 hips analyzed after THA indicated for degenerative arthritis. At five-year follow-up, 103 subjects remained for final analysis. All patients received a zero, three, or multi-hole R3 acetabular shell with Stiktite porous coating (Smith & Nephew, Inc., Memphis, TN, USA). Standard THA surgical techniques were employed, with surgical approach and either of a XLPE or ceramic bearing surface chosen at the discretion of the surgeon. The primary outcome was revision at five-years post-op with secondary outcomes including the Harris Hip Score (HHS), Hip Disability and Osteoarthritis Outcome Score (HOOS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), radiographic analysis, and post-operative adverse events. Data and outcomes were analyzed using summary statistics with 95% confidence intervals, t-tests, and Wilcoxon Rank tests. At five-year follow-up the overall success rate was 97.14% (95% CI: 91.88–100). When analyzed by liner type, the success rate was 96.81% (95% CI: 90.96–99.34) for polyethylene (n=94) and 100% (95% CI: 71.51–100) for ceramic (n=11), with no significant difference between either liner type (p=1). There were three revisions during the study (1.9%), two for femoral stem revision post fracture, and one for deep infection. The HHS (51.36 pre-op, 94.50 five-year), all 5 HOOS sub-scales, and WOMAC (40.9 pre-op, 89.13 five-year) scores all significantly improved (p < 0 .001) over baseline scores at all follow-up points. One (0.7%) subject met the criteria for radiographic failure at one-year post-op but did not require revision. Six (1.8%) of the reported adverse events were considered related to the study device, including four cases of squeaking, one bursitis, and one femur fracture. Results from this five-year, multicenter, prospective study indicate good survivorship for this novel, porous coated acetabular system. The overall survivorship of 97.14% at five-year follow-up is comparable to that reported for similar acetabular components and aligns with previous analyses (Teoh et al. 2018)

Aim: To present the results of trochanteric reduction osteotomy for treatment of resistant trochanteric bursitis. Methods: Trochanteric reduction osteotomy was performed on ten patients. All patients had been conservatively managed for at least one year with analgesics, anti-inflammatory medications and local steroid injections. All these measures however failed to relieve patients symptoms. The senior author performed trochanteric reduction osteotomy and the osteotomy site was fixed using screws. Patients were assessed pre and postoperatively with a minimum follow-up of six months using oxford hip and modified UCLA scores. Results and Conclusions: Patient demography, patient selection, surgical technique and results will be presented. All patients were followed-up for a minimum period of six months at regular intervals before being discharged. Early results are very encouraging. Trochanteric reduction osteotomy is a good treatment option in the management of resistant GT bursitis who do not respond to conservative treatment as most of the patients were disabled before operation