Giant iliopectineal bursitis presenting as neuropathy and severe edema of the lower limb: case illustration and review of the literature

Advanced osteoarthritis of the hip as reason for extensive asymmetric leg edema: a rare case report and review of the literature

An enlarged iliopectineal bursa (IB) can cause pressure on iliofemoral veins. Clinical presentation can manifest as asymmetrical lower extremity edema. This case report demonstrates extensive asymmetrical leg edema caused by femoral vein compression based on iliopectineal bursitis (IB-itis) associated with advanced osteoarthritis (OA) of the left hip joint with an outline of relevant current literature. A female patient presented with left hip pain and edema in the leg. X-ray showed severe OA of the left hip. Computed Tomography (CT) concluded a cystic abnormality at the left iliopsoas muscle associated with the joint consistent with IB-itis, associated with a degenerative left hip joint. Hybrid total hip replacement was performed. At three-month follow-up her left leg showed no longer signs of extensive edema and she walked without the use of walking aids. IB-itis is mostly associated with rheumatoid arthritis (RA). There are no reports which only describe OA as cause of IB-itis. Extensive asymmetrical leg edema can be caused by venous compression of the femoral vein by an IB-itis. If the latter is the consequence of advanced hip OA, a total hip replacement can yield excellent clinical outcomes both functionally and with regard to the edema.

Endoscopic Resection for Iliopectineal Bursitis Associated With Developmental Dysplasia of the Hip

Iliopectineal bursitis usually develops subsequent to other hip pathologies and can often be treated conservatively. However, when conservative treatment fails or the enlarged bursa causes pain or compression of the surrounding neurovascular structures, surgery may be required. Most previous studies have described open surgeries, and reports on endoscopy are very limited. We present a case of iliopectineal bursitis associated with developmental dysplasia of the hip (DDH) that was successfully treated endoscopically. A 16-year-old female with a one-year history of right inguinal pain was referred to our department. She was diagnosed with a hip ganglion and treated with needle aspiration nine times by her previous doctor. Radiographs revealed bilateral DDH without narrowing of the joint space. Magnetic resonance imaging revealed a distinct mass in the deep layer of the iliopsoas muscle, and communication between the mass and the hip joint was observed on ultrasonography. Endoscopic debridement and resection were performed based on the diagnosis of iliopectineal bursitis. We partially debrided the medial side of the rectus femoris muscle toward the deep layer and resected the bursa. We observed a burst of concentrated content from the bursa and confirmed the disappearance of the mass by intraoperative ultrasonography. The postoperative course was good, and there were no functional restrictions or symptom recurrence at two-year postoperatively. Endoscopic resection for repetitive iliopectineal bursitis without an intraarticular procedure does not induce hip instability in patients with DDH and is a minimally invasive cosmetic procedure, and superior to open surgery, especially in young women.

An unusual case of hip pain after total hip arthroplasty: A case report

Our goal is to draw attention to the inflammation of the iliopectineal bursa being a rare condition, which can cause lower limb swelling and anterior pain of the hip even years after total hip arthroplasty. A 67-year-old woman was admitted seven years after hip arthroplasty (cemented total endoprosthesis [TEP]) with swelling and feeling of excessive fullness of the lower extremity and with tolerable anterior hip pain. The physical examination and blood tests were non-specific for septic condition. Ultrasound showed a cystic mass in the inguinal region with a direct contact to the common femoral vein. Deep vein thrombosis was excluded. The single-photon emission computed tomography-computed tomography (SPECT-CT) was administered to decide the surgical plan, either making a bursa extirpation or making revision hip arthroplasty. The SPECT-CT excluded the possibility of aseptic loosening. Methylene blue was injected into the bursa intraoperatively which did not enter the strong pseudo-capsule of the joint and, therefore, we did not administer revision of the TEP, and the bursa was extirpated. Two weeks after the operation, the patient had no pain, was able to walk, and the swelling decreased. Four months after surgery, the pain and feeling of fullness disappeared, with minimal lower limb swelling. In conclusion, in case of increasing complaints of patients who left years behind without any problem following total hip arthroplasty, the pathogenic role of the iliopectineal bursa should be taken into account, after excluding more frequent causes such as aseptic loosening or periprosthetic joint infection. As long as we consider about a rare disease, we can find a solution to the patient's complaint sooner.

Giant hemorrhagic trochanteric bursitis mimicking a high-grade soft tissue sarcoma: report of two cases

BACKGROUND

The giant haemorrhagic bursitis of the hip joint is a rare clinical condition that requires evidence-based guidelines for adequate diagnosis and management. Usually, this pathology requires conservative treatment; however, when abnormal size or clinical symptoms of compression of the surrounding noble structures are reported, an accurate differential diagnosis is required, in order to exclude other malignant conditions that can be included into differential diagnosis, and a surgical approach should be considered. The purpose of this work is to provide an appropriate description of the diagnostic and therapeutic path, providing an accurate analysis of the possible differential diagnoses.

METHODS

We report 2 cases of symptomatic haemorrhagic bursitis of the hip joint, confirmed by histological investigation. In both cases, the patients complained a peripheral nerve deficit of a single limb: one patient presented paresthesia of lateral femoral cutaneous nerve while the second peripheral edema due to compression of the proximal venous and lymphatic circulation.

RESULTS

Both cases were successfully managed by complete surgical excision of the mass, with no  recurrence. There were no major complications, but in first case the nerve deficit was permanent.

CONCLUSIONS

Giant hemorrhagic trochanteric bursitis is a rare condition, but it should be included in the differential diagnosis of soft tissue masses arising from the hip joint. Due to the rarity of this entity, a cautious exclusion process of all plausible differential diagnosis must be undertaken, in order to not miss the possibility of soft-tissue tumors, primarily malignant high-grade sarcomas.

Minimum 5-year follow-up of arthroscopic treatment of symptomatic iliopectineal cyst

INTRODUCTION

We aimed to primarily assess the clinical and functional outcomes of arthroscopic treatment of the symptomatic iliopectineal cyst at a minimum 5-year follow-up. Our secondary objective was to document the technical nuances of our arthroscopic technique.

METHODS

A retrospective review of chart data was performed for 30 patients who underwent arthroscopic treatment of a symptomatic iliopectineal cyst in the period between 1999 and 2015. The mean age of our patients was 57 (33-78) years. All patients completed a minimum follow-up period of 5 years. Our clinical outcomes were assessed by 100 mm VAS for pain, recurrence rate and complications. Functional outcome was evaluated by the modified Harris hip score (mHHS). Patients were asked their level of satisfaction with surgery on a scale of 0-10.

RESULTS

In all patients, the valve mechanism of the iliopectineal cyst could be released arthroscopically and the cyst could be completely evacuated. The preoperative symptoms disappeared within 3-6 weeks after the arthroscopic intervention. Patients showed significant improvement in VAS and mHHS 6 months postoperatively and at final follow-up. The average patient satisfaction was 9.2 at 6 months postoperative and 7.9 at final follow-up. None of our patients experienced any complications. At the final follow-up, there was neither clinical nor radiological evidence of cyst recurrence.

CONCLUSIONS

Arthroscopic treatment of the iliopectineal cyst is a feasible and safe alternative to open surgery resulting in significant improvement of clinical and functional outcomes.

Cystic lesion around the hip joint

This article presents a narrative review of cystic lesions around the hip and primarily consists of 5 sections: Radiological examination, prevalence, pathogenesis, symptoms, and treatment. Cystic lesions around the hip are usually asymptomatic but may be observed incidentally on imaging examinations, such as computed tomography and magnetic resonance imaging. Some cysts may enlarge because of various pathological factors, such as trauma, osteoarthritis, rheumatoid arthritis, or total hip arthroplasty (THA), and may become symptomatic because of compression of surrounding structures, including the femoral, obturator, or sciatic nerves, external iliac or common femoral artery, femoral or external iliac vein, sigmoid colon, cecum, small bowel, ureters, and bladder. Treatment for symptomatic cystic lesions around the hip joint includes rest, nonsteroidal anti-inflammatory drug administration, needle aspiration, and surgical excision. Furthermore, when these cysts are associated with osteoarthritis, rheumatoid arthritis, and THA, primary or revision THA surgery will be necessary concurrent with cyst excision. Knowledge of the characteristic clinical appearance of cystic masses around the hip will be useful for determining specific diagnoses and treatments.