Greater trochanteric pain syndrome (GTPS) is common, yet the impact on function and quality of life has not been measured. The aim of this study was to quantify the impact on function and quality of life, comparing the results to people with severe hip osteoarthritis and an asymptomatic control group. Forty two people with GTPS – including 11 not actively seeking treatment and 11 seeking surgical treatment, 20 with severe hip osteoarthritis (OA), and 23 age and sex matched asymptomatic participants (ASC) where recruited from public and private hospitals, and the community. Upon confirming meeting inclusion and exclusion criteria participants were interviewed. Exclusion criteria included lumbar nerve root signs; inflammatory, neoplastic and metabolic disorders. Measured used were the Harris hip score (HHS); the Oswestry disability index (ODI); the Australian quality of life instrument (AQoL); the Functional co-morbidity index (FCI); and fulltime work assessments. No difference was found between the GTPS and the OA group on the HHS, ODI, AQoL or the FCI measures. Both symptomatic groups were significantly more disabled than the ASC group on the HHS and ODI (p<0.001). The GTPS and OA groups had lower AQoL than the ASC group (p<0.001); and higher FCI results than the ASC group (GTPS vs ASC, p=0.005; OA vs ASC, p=0.019). GTPS participants were least likely to be in full time work; full time work participation probability (95% C.I.): GTPS Prob=0.288 (0.160 to 0.463), OA Prob= 0.518 (0.273 to 0.753); ASC group of Prob=0.676 (0.439 to 0.847). People with GTPS have similar levels of pain, disability and quality of life, but are less likely to be in full time employment than people with severe hip OA which puts them at risk of economic hardship. Research on conservative and surgical treatments should measure pain, disability and work participation.
Severe and recalcitrant Greater Trochanteric Pain Syndrome (GTPS), previously known as Trochanteric bursitis, has been associated with torn gluteal tendons. The aim of this study was to assess the physical, functional and quality of life outcomes of combined bursectomy and gluteal tendon reconstructive surgery. 24 patients underwent combined bursectomy and gluteal tendon reconstruction under one surgeon. They were contacted by mail, email, and telephone. 16 were available for examination, two had revision surgery, one had interview only, one moved interstate, one declined and three were lost to follow up. An independent standardised assessment was undertaken. Hip muscle strength was measured by hand-held dynamometry. Trendelenburg sign was measured according to Hard-castle’s protocol and by observing gait. Functional and quality of life measures were assessed via the Harris Hip Score and the Oswestry Disability scale. Pain and satisfaction was measured via a 10cm visual analogue scale. All patients were female. The mean time from surgery was 18.9 months +/− 8.50. 10 had right sided surgery. The two patients who had revision surgery are not included in this data. Strength of hip abduction was weaker on the ipsilateral side (p<
=.05). External rotation appeared to be weaker, however this was not statistically significant. Hardcastle’s single leg standing Trendelenburg sign was shorter on the ipsilateral side (16.3secs +/− 12.3 vs 22.1secs +/− 10.1, p<
=.05). Five patients had an ipsilateral Trendelenburg gait, two had a contralateral Trendelen-burg gait. The mean recalled preoperative pain score was 67.73 +/− 31.51 out of 100. The mean post operative score was 14.44 +/− 16.1 (p<
=.0005). Patient satisfaction with the results of surgery was rated at 80.7 +/−17.69, out of 100. With regard to function, the mean post operative Harris hip score was 70.9 +/− 25.73 out of 91, and the Oswestry disability score was 15.5 +/− 11.39, out of 100 where a low score indicates better outcome. Combined bursectomy and gluteal tendon reconstruction appears to be an effective procedure for the relief of pain in patients with recalcitrant GTPS in most patients. High patient satisfaction levels suggest that function and quality of life are improved following surgery. A prospective longitudinal study has commenced to verify these results.
