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Kazmin AI, Pereverzev VS, Tesakova DD, Kolesov SV. The role of the greater trochanter pain syndrome in lumbar degenerative disc disease surgery. INTERNATIONAL ORTHOPAEDICS 2024; 48:1897-1902. [PMID: 38743297 DOI: 10.1007/s00264-024-06214-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 05/07/2024] [Indexed: 05/16/2024]
Abstract
PURPOSE Greater trochanter pain syndrome (GTPS) is highly discussed during spine surgeons, accompanies lumbar pain and complicates differential diagnosis. The aim is to raise awareness among physicians and demonstrate the lumbar spine degenerative diseases (LSDD) association with GTPS. METHODS A retro-prospective analysis enrolled 172 patients with LSDD with GTPS signs. Group I - retrospective (n = 112), group II - prospective (n = 60). Patients of group II with the confirmed diagnosis clinically and by the ultrasound recieved a GCS injection (Betamethasone 2 mg\ml + 5 mg\ml - 1.0). Also the VAS, X-ray and SPSS Statistics package were used. RESULTS 112 patients in group I, 89 (79.5%) had increased pain in the hip early postOp to 7.8 points by VAS. All patients required trigger point injections of GCS and 68 (77%) received a repeat injection. 76 from 112 patients were tracked for long-term results, and recurrence of GTPS was detected in five people who treated conservatively for three months without dynamics. They were identified GTPS by ultrasound. During the injection, 39 from 43 (90%) patients noted pain reduction to 2.1 by VAS, but symptoms of radiculopathy or spinal stenosis persisted. Two patients (5%) did not note any changes. Two patients (5%) noted complete pain regression and refused the surgery. CONCLUSION Timely detection of GTPS among spinal surgeons influences tactics and, in some cases, allows one to avoid unnecessary surgical interventions. In turn, ignoring the symptoms of GTPS in the preoperative period can lead to pain intensification in the greater trochanter after surgery for degenerative diseases of the spine.
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Affiliation(s)
- Arkadii I Kazmin
- Department of Spine Pathology, N. N. Priorov National Medical Research Center, Priorov Str., 10, 127299, Moscow, Russia.
| | - Vladimir S Pereverzev
- Department of Spine Pathology, N. N. Priorov National Medical Research Center, Priorov Str., 10, 127299, Moscow, Russia
| | - Darya D Tesakova
- Department of Spine Pathology, N. N. Priorov National Medical Research Center, Priorov Str., 10, 127299, Moscow, Russia
- Department of Traumatology and Orthopedics, Russian Medical Academy of Continuous Professional Education, Barrikadnaya Str., 2/1, B. 1, 125993, Moscow, Russia
| | - Sergey V Kolesov
- Department of Spine Pathology, N. N. Priorov National Medical Research Center, Priorov Str., 10, 127299, Moscow, Russia
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Kjeldsen T, Hvidt KJ, Bohn MB, Mygind-Klavsen B, Lind M, Semciw AI, Mechlenburg I. Exercise compared to a control condition or other conservative treatment options in patients with Greater Trochanteric Pain Syndrome: a systematic review and meta-analysis of randomized controlled trials. Physiotherapy 2024; 123:69-80. [PMID: 38295551 DOI: 10.1016/j.physio.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/14/2023] [Accepted: 01/01/2024] [Indexed: 02/02/2024]
Abstract
OBJECTIVES To estimate the effectiveness of exercise at end of treatment and long-term follow-up compared to a control condition or other conservative treatments in patients with Greater Trochanteric Pain Syndrome (GTPS). METHODS Databases were searched September 2021 and updated September 2023. Randomized controlled trials (RCT) comparing exercise interventions for patients with GTPS, to a control condition; corticosteroid injection; shock wave therapy; or other types of exercise programs were included. Risk of bias was assessed using the ROB2 tool. Meta-analyses were performed using a random-effects model. The certainty of the evidence was rated by the GRADE approach. RESULTS Six RCTs including a total of 733 patients with GTPS were included. Three trials compared exercise to sham exercise or wait-and-see control groups, two trials compared exercise to corticosteroid injection, two trials compared exercise to shockwave therapy, and one trial compared exercise to another type of exercise. Meta-analyses showed that in the long term, exercise slightly reduces hip pain and disease severity, while slightly improving patient-reported physical function and global rating of change compared to a control condition. No serious adverse events were reported. Compared to corticosteroid injection, exercise improves long-term global rating of change. CONCLUSION The current evidence supports a strong recommendation for exercise as first line treatment in patients clinically diagnosed with GTPS. Compared to corticosteroid injection, exercise is superior in increasing the likelihood that a patient experiences a meaningful global improvement. These results are based on few trials and a moderate number of patients. REGISTRATION This review was prospectively registered in the PROSPERO database of systematic reviews (ID: CRD42021261380). CONTRIBUTION OF PAPER.
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Affiliation(s)
- Troels Kjeldsen
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Denmark.
| | | | - Marie Bagger Bohn
- H-HiP, Department of Orthopaedic Surgery, Horsens Regional Hospital, Denmark; Department of Public Health, Aarhus University, Aarhus, Denmark
| | | | - Martin Lind
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Adam Ivan Semciw
- Department of Physiotherapy, Podiatry and Prosthetics and Orthotics, La Trobe University, Australia; Department of Allied Health, Northern Health, Australia
| | - Inger Mechlenburg
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Public Health, Aarhus University, Aarhus, Denmark
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Wadekar S, Gaddis JM, Middleton E, Xi Y, Mulligan E, Bialaszewski R, Laboret B, Wells J. The Morbidity of Greater Trochanteric Pain Syndrome Versus That of Patients Awaiting Total Hip Replacement. Orthopedics 2024:1-6. [PMID: 38810128 DOI: 10.3928/01477447-20240520-03] [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] [Indexed: 05/31/2024]
Abstract
BACKGROUND Greater trochanteric pain syndrome (GTPS) is a commonly diagnosed medical issue, yet there are little data assessing the relative morbidity of GTPS. We sought to characterize the morbidity on presentation of GTPS and compare it to that of patients with end-stage hip osteoarthritis awaiting total hip arthroplasty. We hypothesized that patients with GTPS would have morbidity similar to or worse than that of patients with osteoarthritis. MATERIALS AND METHODS This retrospective case-control study examined patient-reported outcome measures of 156 patients with GTPS (193 hips) and 300 patients with hip osteoarthritis before total hip arthroplasty (326 hips). Patients with secondary hip conditions or previous hip surgeries were excluded from the study. Patient-reported outcome measures were analyzed using an equivalence test and two one-sided t tests. RESULTS Equivalence in mean visual analog scale pain scores between GTPS and osteoarthritis was established with a tolerance margin of ±10. The difference in mean visual analog scale pain scores was 0.35 (95% CI, -0.86 to 0.16; P=.02). The Hip disability and Osteoarthritis Outcome Score Quality of Life was much worse for patients with GTPS, placed well outside of the ±10 tolerance margin, and the difference in mean scores was 1.72 (95% Cl, -2.17 to -1.26; P=.99). Equivalence in mean UCLA Activity scores between GTPS and osteoarthritis was established with a tolerance margin of ±5. The difference in mean UCLA Activity scores was 0.002 (95% CI, -0.45 to 0.43; P<.01). CONCLUSION The morbidity and functional limitations of patients with GTPS were similar to those of patients undergoing total hip arthroplasty. GTPS remains a functional problem for patients, and clinicians and researchers should consider GTPS as seriously as hip osteoarthritis. [Orthopedics. 202x;4x(x):xx-xx.].
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Kahana-Rojkind AH, McCarroll TR, Kuhns BD, Parsa A, Quesada-Jimenez R, Domb BG. Parachute Technique for Dermal Allograft Augmentation in Open Gluteal Abductor Repair. Arthrosc Tech 2024; 13:102958. [PMID: 38835452 PMCID: PMC11144959 DOI: 10.1016/j.eats.2024.102958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 01/15/2024] [Indexed: 06/06/2024] Open
Abstract
Retracted full-thickness tears of the gluteus medius tendon are a well-recognized cause of disabling weakness and pain that significantly impact patients' quality of life. We present an efficient knotless parachute technique for dermal allograft augmentation in open gluteal abductor tendon repairs. Our technique reinforces the suture-tendon interface by incorporating a robust biological scaffold into a knotless double-row fixation. This approach capitalizes on the increased pressure and contact area achieved between the greater trochanter and the dermal allograft/gluteus medius tendon construct without the prominence of knotted sutures.
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Affiliation(s)
| | | | - Benjamin D. Kuhns
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - Ali Parsa
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | | | - Benjamin G. Domb
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
- American Hip Institute, Chicago, Illinois, U.S.A
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Atilano L, Martin N, Ignacio Martin J, Iglesias G, Mendiola J, Bully P, Aiyegbusi A, Manuel Rodriguez-Palomo J, Andia I. Ultrasound-Guided Subfascial Platelet-Rich Plasma Injections Versus Enthesis Needling for Greater Trochanteric Pain Syndrome: A Randomized Controlled Trial. Orthop J Sports Med 2024; 12:23259671241249123. [PMID: 38751852 PMCID: PMC11095191 DOI: 10.1177/23259671241249123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 11/21/2023] [Indexed: 05/18/2024] Open
Abstract
Background Greater trochanteric pain syndrome (GTPS) is characterized by gluteal enthesopathy involving the peritrochanteric space and associated with chronic pain and functional impairment. A corticosteroid injection in the trochanteric bursa is the usual palliative treatment for pain. However, it is important to investigate treatment options that will relieve pain in the peritrochanteric space. Purpose To compare the clinical efficacy of subfascial platelet-rich plasma (PRP) injection and enthesis needling for GTPS. Study Design Randomized controlled trial; Level of evidence, 1. Methods A total of 92 patients (90% women; mean age, 55 years old; mean body mass index, 25.3 kg/m2) were randomly divided into a subfascial PRP injection group and an enthesis needling group. Descriptive data and radiographic measurements of the pelvis-including leg-length difference, pelvic width difference, and pelvic trochanteric index-were recorded. The primary outcome measures were the Hip Outcome Score (HOS) activities of daily living (HOS-ADL) and sports-specific (HOS-SS) subscales and the visual analog scale for pain at 3, 6, and 12 months posttreatment. In addition, we evaluated the presence or absence of ultrasound characteristics (fascia nodules, trochanteric bursa distension, and calcium deposits) over time in response to treatment. Results Baseline demographic and radiological characteristics were similar between the groups. The PRP group saw significantly greater improvement from baseline to 12 months posttreatment on the HOS-SS subscore compared with the needling group (32.09 [95% CI, 28.99-40.20] vs 20.52 [95% CI, 11.99-29.05]; P = .048). At 3 months, 60% of patients in the PRP group versus 33.3% in the needling group had a reduction in pain compared with a baseline of >20% (P = .040). After subfascial PRP injection, fewer patients had a fascia nodule over the trochanter and/or bursa distension (P = .006 and P = .004, respectively). The pelvic trochanteric index was predictive of HOS-ADL and HOS-SS outcomes (P = .011 and P = .022, respectively). The interaction between treatment modality and fascia nodule influenced HOS-ADL and HOS-SS outcomes (P = .021 and P = .023) as well as the interactions of treatment modality, fascia nodules, and calcifications (P = .027). Conclusion Both subfascial PRP injection and enthesis needling resulted in clinical improvements, but the improvement in the HOS-SS was greater in the PRP group. Registration NCT04231357 (ClinicalTrials.gov identifier).
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Affiliation(s)
- Leire Atilano
- Regenerative Therapies, Biobizkaia Health Research Institute, Cruces University Hospital, Barakaldo, Bizkaia, Spain
- Interventional Unit, Radiodiagnostic Service, Cruces University Hospital, Barakaldo, Bizkaia, Spain
| | - Nerea Martin
- Regenerative Therapies, Biobizkaia Health Research Institute, Cruces University Hospital, Barakaldo, Bizkaia, Spain
- Orthopaedic Surgery Service, Cruces University Hospital, Barakaldo, Bizkaia, Spain
| | - Jose Ignacio Martin
- Regenerative Therapies, Biobizkaia Health Research Institute, Cruces University Hospital, Barakaldo, Bizkaia, Spain
- Interventional Unit, Radiodiagnostic Service, Cruces University Hospital, Barakaldo, Bizkaia, Spain
| | - Gotzon Iglesias
- Regenerative Therapies, Biobizkaia Health Research Institute, Cruces University Hospital, Barakaldo, Bizkaia, Spain
- Interventional Unit, Radiodiagnostic Service, Cruces University Hospital, Barakaldo, Bizkaia, Spain
| | - Josu Mendiola
- Regenerative Therapies, Biobizkaia Health Research Institute, Cruces University Hospital, Barakaldo, Bizkaia, Spain
- Interventional Unit, Radiodiagnostic Service, Cruces University Hospital, Barakaldo, Bizkaia, Spain
| | - Paola Bully
- Methodological and Statistical Consulting, Sopuerta, Bizkaia, Spain
| | - Ayoola Aiyegbusi
- Department of Physiotherapy, Faculty of Clinical Sciences College of Medicine, University of Lagos, Lagos, Nigeria
| | - Jose Manuel Rodriguez-Palomo
- Regenerative Therapies, Biobizkaia Health Research Institute, Cruces University Hospital, Barakaldo, Bizkaia, Spain
- Orthopaedic Surgery Service, Cruces University Hospital, Barakaldo, Bizkaia, Spain
| | - Isabel Andia
- Regenerative Therapies, Biobizkaia Health Research Institute, Cruces University Hospital, Barakaldo, Bizkaia, Spain
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Grimaldi A, Mellor R, Nasser A, Vicenzino B, Hunter DJ. Current and future advances in practice: tendinopathies of the hip. Rheumatol Adv Pract 2024; 8:rkae022. [PMID: 38601140 PMCID: PMC11003818 DOI: 10.1093/rap/rkae022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 02/25/2024] [Indexed: 04/12/2024] Open
Abstract
Tendinopathy describes persistent tendon pain and loss of function related to mechanical loading. Two common hip tendinopathies seen in practice are gluteal tendinopathy and proximal hamstring tendinopathy. Both conditions can be frustrating for patients and clinicians due to the delay in diagnosis, significant disability caused and lack of response to common treatments. Tendinopathy is a clinical diagnosis and can most often be made using findings from the patient interview and pain provocation tests, without the need for imaging. Specific education and progressive exercise offer a low-risk and effective option for gluteal tendinopathy and result in greater rates of treatment success than corticosteroid injection, both in the short term (8 weeks) and at 1 year. Proximal hamstring tendinopathy is a common, but less researched, and under-recognized cause of persistent ischial pain. As research on proximal hamstring tendinopathy is limited, this review summarizes the available evidence on diagnosis and treatment following similar principles to other well-researched tendinopathies.
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Affiliation(s)
- Alison Grimaldi
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia
- PhysioTec, Tarragindi, Queensland, Australia
| | - Rebecca Mellor
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia
- Gallipoli Medical Research, Greenslopes, Queensland, Australia
| | - Anthony Nasser
- Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia
- La Trobe Sports and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Bill Vicenzino
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - David J Hunter
- Sydney Musculoskeletal Health, Kolling Institute, University of Sydney, Sydney, New South Wales, Australia
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Fearon AM, Grimaldi A, Mellor R, Nasser AM, Fitzpatrick J, Ladurner A, Vicenzino B. ICON 2020-International Scientific Tendinopathy Symposium Consensus: the development of a core outcome set for gluteal tendinopathy. Br J Sports Med 2024; 58:245-254. [PMID: 38216320 DOI: 10.1136/bjsports-2023-107150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2023] [Indexed: 01/14/2024]
Abstract
Gluteal tendinopathy (GT) is common and can be debilitating and challenging to manage. A lack of condition specific and appropriate outcome measures compromise evidence synthesis for treatment and limits clinical guideline development. Our objective was to develop a core outcome measurement set for GT (COS-GT). Participants were patients with GT and expert health professionals (HPs). A scoping review identified measures used in GT research, which were mapped to the nine International Scientific Tendinopathy Symposium Consensus core domains, and included in two surveys of HPs. The first survey identified the feasible and true measures for each domain. The second survey refined the list which a patient focus group then considered. Meeting online, HPs reached consensus (agreement ≥70%) on the most appropriate COS-GT measures. 34 HPs and seven patients were recruited. 57 measures were mapped to the nine core domains. Six measures did not proceed past survey one. Of those that progressed, none had adequate clinimetric properties for a COS-GT. Thus, participants decided on interim measures: the global rating of change, pain at night, time to pain onset with single limb stance, pain with stair walking, pain self-efficacy and hip abduction strength. HP participants additionally recommended that pain over the last week, the European Quality of Life-5 dimensions-5 levels and the Victorian Institute of Sport Assessment-Gluteal be considered in clinical trials, as they currently provide best easures of the relevant tendinopathy domains. In conclusion this interim COS-GT should guide outcome measure selection in clinical practice and future research trials in patients with GT.
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Affiliation(s)
- Angela M Fearon
- Faculty of Health, University of Canberra Research Institute for Sport and Exercise, Bruce, Australian Capital Territory, Australia
- Trauma and Orthopaedic Research Unit, Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Alison Grimaldi
- University of Queensland Physiotherapy, St Lucia, Queensland, Australia
- PhysioTec Physiotherapy, Brisbane, Queensland, Australia
| | - Rebecca Mellor
- University of Queensland Physiotherapy, St Lucia, Queensland, Australia
- Gallipoli Medical Research Foundation, Greenslopes, Queensland, Australia
| | | | - Jane Fitzpatrick
- The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Melbourne, Victoria, Australia
- Research Committee, Australasian College of Sport and Exercise Physicians, Melbourne, Victoria, Australia
| | - Andreas Ladurner
- Orthopaedics and Traumatology, Kantonsspital St Gallen, Sankt Gallen, Switzerland
| | - Bill Vicenzino
- Physiotherapy, The University of Queensland, Saint Lucia, Queensland, Australia
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Citaker S, Arikan H, Maras G, Ayas IH, Yazgan-Dagli B. Translation, reliability, and validity of the Turkish version of the Victorian Institute of Sports Assessment For Gluteal Tendinopathy (VISA-G) questionnaire in individuals with greater trochanteric pain syndrome. Physiother Theory Pract 2024; 40:617-624. [PMID: 36170045 DOI: 10.1080/09593985.2022.2127139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 09/13/2022] [Accepted: 09/13/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Greater trochanteric pain syndrome (GTPS) is a common cause of lateral hip pain. OBJECTIVE The objectives of this study were to translate the Victorian Institute of Sports Assessment for Gluteal Tendinopathy (VISA-G) questionnaire into the Turkish language and to examine its reliability and validity. METHODS 108 individuals (45 female, 63 male) participated in the translation and the reliability and validity analysis. The original VISA-G questionnaire was translated into Turkish language using Beaton guidelines. The Turkish version of the VISA-G, Harris Hip Score (HHS), Oswestry Disability Index (ODI), Oxford Hip Score (OHS), and International Physical Activity Questionnaire (IPAQ) were applied to 108 individuals with GTPS for convergent validity. The VISA-G was retested to investigate its reliability after one week. RESULTS The VISA-G had a good correlation with HHS (r = 0.694, p < .001), ODI (r = -0.659, p < .001), OHS (r = 0.678, p < .001), and IPAQ (r = 0.440, p < .001). The reliability and internal consistency were excellent (ICC (2,1) value = 0.943; Cronbach's α = 0.946, respectively). And no floor and ceiling effects were revealed related VISA-G. CONCLUSION The Turkish version of the VISA-G has good validity and excellent reliability. It can be used in clinical and research practices in the Turkish population with GTPS.
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Affiliation(s)
- Seyit Citaker
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Gazi University, Bişkek Street 06490, Cankaya, Turkey
| | - Halime Arikan
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Tokat Gaziosmanpasa University, Taşlıçiftlik Campus, 60250, Turkey
| | - Gokhan Maras
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Gazi University, Bişkek Street 06490, Cankaya, Turkey
| | - Inci-Hazal Ayas
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Gazi University, Bişkek Street 06490, Cankaya, Turkey
| | - Beyza Yazgan-Dagli
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Gazi University, Bişkek Street 06490, Cankaya, Turkey
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Karaoğlan M, Küçükçay Karaoğlan B. PENG for chronic pain: the clinical effectiveness of pericapsular nerve group block in chronic hip pain. Hip Int 2024:11207000241227542. [PMID: 38380579 DOI: 10.1177/11207000241227542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
OBJECTIVES To evaluate the efficiency and tolerability of pericapsular nerve group block (PENG) for the treatment of chronic hip pain. METHODS This is a retrospective, single-centre, 4-group study conducted over a 3-month period to find out the most typical cause of chronic hip pain. A total of 112 patients with symptomatic hip osteoarthritis (OA), Stage 2-3, greater trochanteric pain (GTPS) and chronic pain after total hip arthroplasty (cTHA), who had an ultrasound-guided PENG block, were selected. To assess the effectiveness of the treatment, the Western Ontario and McMaster Universities osteoarthritis index (WOMAC) and visual analogue scale (VAS) scores of the patients prior to treatment were compared with their scores after the 1st week, 1st month, and 3rd month of treatment. The study also aimed to analyse the patients' initial feelings of alleviation following the block (1st VAS/2) and problems experienced both during and after the block. RESULTS The parameters studied included pain, stiffness, and results of physical activity in the 1st week, 1st month, and 3rd month following PENG block application. At the beginning of the 1st week, of the 112 patients who were administered a PENG block for hip pain, we reported a 62% improvement in pain, a 52% reduction in stiffness, and a 53% increase in physical activity. Even though these results slightly declined in the 1st and 3rd months, the rates were still higher than 45%. CONCLUSIONS Overall, the PENG block was well-tolerated by the patients in our study. No treatment-related infections or any other serious complications were observed.
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Foxcroft B, Stephens G, Woodhead T, Ayre C. What factors influence pain scores following Corticosteroid injection in patients with Greater Trochanteric Pain Syndrome? A systematic review. BMC Musculoskelet Disord 2024; 25:149. [PMID: 38365672 PMCID: PMC10874005 DOI: 10.1186/s12891-024-07217-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 01/20/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Cortico-Steroid Injections (CSI) are commonly used to treat patients with Greater Trochanteric Pain Syndrome (GTPS) but it is unclear which patients will experience improvements in pain. OBJECTIVES To identify factors that influence improvements in pain for patients with GTPS treated with CSI. DESIGN Systematic review. METHODS A search was undertaken of AMED, CINAHL, Cochrane Library, EMBASE, Medline and PEDro databases. Studies were eligible for inclusion if they investigated factors that influenced changes in pain experienced by patients with GTPS who received a CSI. Studies needed to include relevant summary statistics and tests of clinical significance. Risk Of Bias in Non-randomised Trials Of Interventions (ROBINS-I) and Risk Of Bias 2 (ROB2) tools were used to assess bias. RESULTS The search identified 466 studies, 8 were included in the final review with a total of 643 participants. There was no association between demographic variables such as age, sex, symptom duration or obesity and pain outcomes post-CSI. Having a co-existing musculoskeletal (MSK) condition such as knee osteoarthritis or sacroiliac/lumbar spine pain was associated with less pain reduction post-CSI. Injections into the Trochanteric Bursa were associated with longer lasting pain reduction than Gluteus Medius Bursa or extra-bursal injections. Image guidance of CSI maintained lower pain scores at six months but did not increase the duration of the therapeutic effect past six months. The presence of specific ultrasound scan features was not associated with differences in pain scores. CONCLUSIONS Patients with co-existing MSK conditions may not respond to CSI as well as those without. Injections into the Greater Trochanteric Bursa may have longer lasting benefit. Further research is needed on the use of USS imaging findings and image guidance.
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Affiliation(s)
- Ben Foxcroft
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, The University of Leeds, Leeds, UK.
- Leeds Community Healthcare NHS Trust, Leeds, UK.
| | - Gareth Stephens
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | | | - Colin Ayre
- The University of Bradford, Bradford, UK
- Bradford Teaching Hospitals NHS Foundation Trust, Duckworth Lane, Bradford, UK
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Patricio Cordeiro TT, Rocha EAB, Scattone Silva R. Effects of exercise-based interventions on gluteal tendinopathy. Systematic review with meta-analysis. Sci Rep 2024; 14:3343. [PMID: 38336959 PMCID: PMC10858207 DOI: 10.1038/s41598-024-53283-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 01/30/2024] [Indexed: 02/12/2024] Open
Abstract
The objective of this review was to evaluate the effect of exercise on pain intensity, function, and quality of life in individuals with gluteal tendinopathy. Searches were carried out in PUBMED, EMBASE, CINAHL, Cochrane Library, and PEDro databases. Randomized or quasi-randomized controlled trials were included. Five studies met the eligibility criteria, comparing exercise-based interventions with minimal interventions and/or corticosteroid injections. Three studies, involving 383 participants, were included in the quantitative analysis. Meta-analyses showed that exercise is superior to minimal intervention for function in short-term [mean difference (MD) = 10.24; 95% confidence interval (95%CI) = 5.98, 14.50) and long-term (MD = 6.54; 95%CI = 1.88, 11.21]). However, no difference was observed for quality of life in the short [standardized mean difference (SMD) = 0.33; 95%CI = -0.29, 0.94] and long-term (SMD = 0.11; 95%CI = -0.16, 0.37). The effect of exercise was no different from that of corticosteroid injections for pain intensity in the short (MD = 1.25; 95%CI = -3.56, 6.05) and long-term (MD = -1.37; 95%CI = -3.72, 0.98]). In conclusion, exercise is superior to minimal interventions for function in the short- and long-term in individuals with gluteal tendinopathy. Exercise and corticosteroid injections had similar effects on pain intensity, however, exercise showed a higher treatment success rate when compared to corticosteroid injections in this population. The GRADE analysis revealed that the certainty of the evidence ranges from low to very low, therefore, large high-quality randomized controlled trials are recommended.PROSPERO registration number: CRD42021242853.
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Affiliation(s)
- Thaisy Thuany Patricio Cordeiro
- Postgraduate Program in Rehabilitation Sciences (PPGCREAB), Health Sciences College of Trairi, Federal University of Rio Grande do Norte (UFRN/FACISA), Santa Cruz, RN, Brazil
- Brazilian Tendinopathy and Sports Injuries Research Group (BRATSI), Federal University of Rio Grande do Norte, Santa Cruz, RN, Brazil
- Postgraduate Program in Physical Therapy (PPGFIS), Federal University of Rio Grande do Norte (UFRN), Natal, RN, Brazil
| | - Emannuel Alcides Bezerra Rocha
- Postgraduate Program in Rehabilitation Sciences (PPGCREAB), Health Sciences College of Trairi, Federal University of Rio Grande do Norte (UFRN/FACISA), Santa Cruz, RN, Brazil
- Brazilian Tendinopathy and Sports Injuries Research Group (BRATSI), Federal University of Rio Grande do Norte, Santa Cruz, RN, Brazil
| | - Rodrigo Scattone Silva
- Postgraduate Program in Rehabilitation Sciences (PPGCREAB), Health Sciences College of Trairi, Federal University of Rio Grande do Norte (UFRN/FACISA), Santa Cruz, RN, Brazil.
- Brazilian Tendinopathy and Sports Injuries Research Group (BRATSI), Federal University of Rio Grande do Norte, Santa Cruz, RN, Brazil.
- Postgraduate Program in Physical Therapy (PPGFIS), Federal University of Rio Grande do Norte (UFRN), Natal, RN, Brazil.
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12
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ROŠKAR S, ROJC M, PODOVŠOVNIK E, TREBŠE R. Psychometric Characteristics, Cross-Cultural Adaptation and Validation of the Slovenian Version of the Victorian Institute of Sports Assessments for Gluteal Tendinopathy Questionnaire (VISA-G). Zdr Varst 2023; 62:167-172. [PMID: 37799417 PMCID: PMC10549249 DOI: 10.2478/sjph-2023-0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 07/06/2023] [Indexed: 10/07/2023] Open
Abstract
Introduction Greater trochanteric pain syndrome (GTPS) denotes several disorders around the lateral aspect of the hip. GTPS may develop in native hips as well as after total hip arthroplasty (THA). It is estimated that 5-12% of patients suffer from GTPS after primary THA. Despite the prevalence of GTPS, it is hard to diagnose and manage it properly. The VISA-G questionnaire was developed as a patient-reported outcome measurement tool for evaluation of GTPS. The aims of the present study were to evaluate the reliability of the VISA-G Slovenian and its construct and criterion validity. Methods After the finalization of the VISA-G Slovenian translation procedure, 59 patients with a painful trochanteric region planned for THA filled in the VISA-G Slovenian at the hospital on two occasions 5-7 days apart. On the first occasion, each patient also filled in the EQ-5D-5L questionnaire and the Harris Hip Score (HHS) was completed by the physiotherapist. Results The VISA-G Slovenian was found to have a test-retest reliability of ICC 0.977; 95% CI [0.96; 0.986]. Internal consistency was assessed with Cronbach's alpha 0.79. The statistically significant, but low, correlation between the HHS and VISA-G (r=0.48) was obtained. Concurrent validity of the VISA-G with the EQ-5D-5L showed moderate to strong correlations in Mobility, Self-Care, Usual Activities, Pain, EQ-5D-5L Index and EQ VAS, but low correlation in the Anxiety subscale. No floor and ceiling effect were obtained. Conclusions The VISA-G Slovenian has excellent psychometric properties needed to measure gluteal tendinopathy-related disability of patients in Slovenia. Thus, we recommend using the questionnaire for measuring trochanteric hip pain.
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Affiliation(s)
- Samo ROŠKAR
- Valdoltra Orthopaedic Hospital, Jadranska cesta 31, 6280Ankaran, Slovenia
- University of Ljubljana, Faculty of Medicine, Zaloška 9, 1000Ljubljana, Slovenia
| | - Marina ROJC
- Valdoltra Orthopaedic Hospital, Jadranska cesta 31, 6280Ankaran, Slovenia
| | - Eva PODOVŠOVNIK
- Valdoltra Orthopaedic Hospital, Jadranska cesta 31, 6280Ankaran, Slovenia
| | - Rihard TREBŠE
- Valdoltra Orthopaedic Hospital, Jadranska cesta 31, 6280Ankaran, Slovenia
- University of Ljubljana, Faculty of Medicine, Zaloška 9, 1000Ljubljana, Slovenia
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13
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Dancy ME, Alexander AS, Clark CJ, Marigi EM, Hevesi M, Levy BA, Krych AJ, Okoroha KR. Gluteal Tendinopathy: Critical Analysis Review of Current Nonoperative Treatments. JBJS Rev 2023; 11:01874474-202310000-00006. [PMID: 37812677 DOI: 10.2106/jbjs.rvw.23.00101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Abstract
» Gluteal tendinopathy/greater trochanteric pain syndrome (GTPS) is the most prevalent of all lower limb tendinopathies, affecting 1 in 4 women older than 50 years and commonly individuals within their fifth and sixth decades of life regardless of activity level.» The condition is believed to originate from age-related degenerative changes about the hip abductor tendon insertions and the surrounding bursae, and is exacerbated by congenital and acquired abnormal hip biomechanics.» Treatment of gluteal tendinopathy/GTPS often begins with noninvasive nonoperative modalities such as activity modifications, nonsteroidal anti-inflammatory drugs, and physical therapy. For recalcitrant symptoms, additional nonoperative therapies have been used; however, there remains a lack of comparative efficacy between these adjunct treatments.» In this article, we examine the available literature regarding the nonoperative management of gluteal tendinopathy/GTPS and provide insight into the effectiveness of current treatment modalities.
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Affiliation(s)
- Malik E Dancy
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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14
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Sveinall H, Wenstad PK, Fearon AM, Skyttemyr G, Thornes E, Skaara HE, Juel NG, Brox JI, Roe C, Johnsen MB. The reliability and validity of the Norwegian version of the Victorian Institute of Sports Assessment for gluteal tendinopathy questionnaire (VISA-G-Norwegian) for patients with greater trochanteric pain syndrome. BMC Musculoskelet Disord 2023; 24:769. [PMID: 37770944 PMCID: PMC10540384 DOI: 10.1186/s12891-023-06901-0] [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: 02/07/2023] [Accepted: 09/20/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND Greater Trochanteric Pain Syndrome (GTPS) is a common chronic musculoskeletal condition that may affect physical function, quality of life and sleep. The Victorian Institute of Sport Assessment-Gluteal questionnaire (VISA-G) has been developed as a Patient-Reported Outcome Measurement (PROM) to address pain, everyday activities, physical activities, and difficulty with weight bearing activities. The aim of the study was to test the reliability, validity and floor and ceiling effects of the Norwegian version of the VISA-G (VISA-G-Norwegian) in a population with GTPS in a specialist health care setting. METHODS This psychometric evaluation of the VISA-G-Norwegian questionnaire were conducted with a prospective observational design. The VISA-G was translated into Norwegian following recommended guidelines. A subgroup repeated the VISA-G-Norwegian a week after the initial submission. For the reliability, the Intraclass Correlation Coefficient (ICC2.1), Standard Error of the Measurement (SEM) and the Smallest Detectable Change (SDC95%) were calculated. Internal consistency was measured using a Cronbach´s alpha. Floor and ceiling effects were evaluated, and construct validity was assessed with three a priori hypotheses. RESULTS 78 participants were included in the study of which 47 stable participants undertook the test-retest reliability arm of the study. The ICC2.1 for the total score was 0.85 (95% CI 0.68, 0.92), SEM was 6.6 points and SDC95% 18.4 points. Cronbach`s alpha was 0.77 (95% CI 0.69, 0.84). No floor or ceiling effects were found in the total score, but ceiling effect was found in three of the eight items. For construct validity, one of the three hypotheses were confirmed. VISA-G-Norwegian correlated to the modified Harris Hip Score (mHHS), Oswestry Disability Questionnaire (ODI) and Numeric Pain Rating Scale (NPRS), 0.64, -0.75 and - 0.63 respectively. CONCLUSION The VISA-G-Norwegian has acceptable reliability and validity, despite ceiling effect of individual items. The large SDC95% should be considered when measuring change in similar cohorts with GTPS. For a potential future version, it would be recommended to consider response options for questions with ceiling effect and the comprehensibility of question eight. TRIAL REGISTRATION Registered at ClinicalTrials.gov the 28/02/2020 (NCT04289922).
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Affiliation(s)
- Håkon Sveinall
- Department of Physical Medicine and rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Per Kristian Wenstad
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, Oslo Metropolitan University, Pilestredet 44, Oslo, 0167, Norway
| | - Angela M Fearon
- University of Canberra Research Institute Sport and Exercise, Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia
- Trauma and Orthopedic Research Unit, Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | | | | | - Heléne Engberg Skaara
- Department of Physical Medicine and rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Niels Gunnar Juel
- Department of Physical Medicine and rehabilitation, Oslo University Hospital, Oslo, Norway
- Department of General Practice, University of Oslo, Oslo, Norway
| | - Jens Ivar Brox
- Department of Physical Medicine and rehabilitation, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| | - Cecilie Roe
- Department of Physical Medicine and rehabilitation, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| | - Marianne Bakke Johnsen
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, Oslo Metropolitan University, Pilestredet 44, Oslo, 0167, Norway.
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15
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Haber T, Hinman RS, Dobson F, Vicenzino B, Darlow B, Kayll S, Hall M. Clinical reasoning in managing chronic hip pain: One in two Australian and New Zealand physiotherapists diagnosed a case vignette with clinical criteria for hip OA as hip OA. A cross-sectional survey. Musculoskeletal Care 2023; 21:763-775. [PMID: 36864703 PMCID: PMC10947065 DOI: 10.1002/msc.1751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 02/14/2023] [Accepted: 02/17/2023] [Indexed: 03/04/2023]
Abstract
OBJECTIVES Using a case vignette of an adult (George) presenting with hip pain consistent with hip OA, this study aimed to describe: (a) whether physiotherapists make diagnoses and identify bodily structures using either patient history and/or physical examination findings; (b) which diagnoses and bodily structures physiotherapists attribute to the hip pain; (c) how confident physiotherapists were in their clinical reasoning using patient history and physical examination findings; (d) what treatments physiotherapists would offer to George. METHODS We conducted a cross-sectional online survey of physiotherapists in Australia and New Zealand. We used descriptive statistics to analyse closed questions and content analysis for open-text responses. RESULTS Two hundred and twenty physiotherapists completed the survey (39% response-rate). After receiving the patient history, 64% diagnosed George's pain and 49% of these as hip OA; 95% attributed George's pain to a bodily structure(s). After receiving the physical examination, 81% diagnosed George's hip pain and 52% of these as hip OA; 96% attributed George's hip pain to a bodily structure(s). Ninety-six percent of respondents were at least somewhat confident in their diagnosis after the patient history, and 95% were similarly confident after the physical examination. Most respondents offered advice (98%) and exercise (99%), but fewer offered treatments for weight loss (31%), medication (11%), and psychosocial factors (<15%). DISCUSSION About half of the physiotherapists that diagnosed George's hip pain made a diagnosis of hip OA, despite the case vignette including clinical criteria for a diagnosis of OA. Physiotherapists offered exercise and education, but many physiotherapists did not offer other clinically indicated and recommended treatments, such as weight loss and sleep advice.
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Affiliation(s)
- Travis Haber
- Centre for Health, Exercise and Sports MedicineDepartment of PhysiotherapySchool of Health SciencesThe University of MelbourneVictoriaAustralia
| | - Rana S. Hinman
- Centre for Health, Exercise and Sports MedicineDepartment of PhysiotherapySchool of Health SciencesThe University of MelbourneVictoriaAustralia
| | - Fiona Dobson
- Centre for Health, Exercise and Sports MedicineDepartment of PhysiotherapySchool of Health SciencesThe University of MelbourneVictoriaAustralia
| | - Bill Vicenzino
- School of Health and Rehabilitation SciencesUniversity of QueenslandSaint LuciaAustralia
| | - Ben Darlow
- Department of Primary Health Care and General PracticeUniversity of Otago WellingtonWellingtonNew Zealand
| | - Sam Kayll
- Centre for Health, Exercise and Sports MedicineDepartment of PhysiotherapySchool of Health SciencesThe University of MelbourneVictoriaAustralia
| | - Michelle Hall
- Centre for Health, Exercise and Sports MedicineDepartment of PhysiotherapySchool of Health SciencesThe University of MelbourneVictoriaAustralia
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16
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Teng WH, Ditta A, Webber J, Pearce O. Excision of trochanteric bursa during total hip replacement: Does it reduce the incidence of post-operative trochanteric bursitis? World J Orthop 2023; 14:533-539. [PMID: 37485424 PMCID: PMC10359745 DOI: 10.5312/wjo.v14.i7.533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/20/2023] [Accepted: 05/25/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Trochanteric bursitis is a common complication following total hip replacement (THR), and it is associated with high level of disability and poor quality of life. Excision of the trochanteric bursa prophylactically during THR could reduce the occurrence of post-operative trochanteric bursitis.
AIM To evaluate whether synchronous trochanteric bursectomy at the time of THR affects the incidence of post-operative trochanteric bursitis.
METHODS This retrospective cohort study was conducted in the secondary care setting at a large district general hospital. Between January 2010 and December 2020, 954 patients underwent elective primary THR by two contemporary arthroplasty surgeons, one excising the bursa and the other not (at the time of THR). All patients received the same post-operative rehabilitation and were followed up for 1 year. We reviewed all cases of trochanteric bursitis over this 11-year period to determine the incidence of post-THR bursitis. Two proportion Z-test was used to compare incidences of trochanteric bursitis between groups.
RESULTS 554 patients underwent synchronous trochanteric bursectomy at the time of THR whereas 400 patients did not. A total of 5 patients (incidence 0.5%) developed trochanteric bursitis following THR; 4 of whom had undergone bursectomy as part of their surgical approach, 1 who had not. There was no statistically significant difference between the two groups (Z value 1.00, 95%CI: -0.4% to 1.3%, P = 0.32). There were also 8 other patients who had both trochanteric bursitis and hip osteoarthritis prior to their THR; all of whom were treated with THR and synchronous trochanteric bursectomy, and 7 had resolution of their lateral buttock pains but 1 did not.
CONCLUSION Synchronous trochanteric bursectomy during THR does not materially affect the incidence of post-operative bursitis. However, it is successful at treating patients with known trochanteric bursitis and osteoarthritis requiring THR.
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Affiliation(s)
- Wai-Huang Teng
- Division of Trauma and Orthopaedics, Milton Keynes University Hospital, Milton Keynes MK6 5LD, United Kingdom
| | - Adeel Ditta
- Division of Trauma and Orthopaedics, Milton Keynes University Hospital, Milton Keynes MK6 5LD, United Kingdom
| | - Jane Webber
- Division of Trauma and Orthopaedics, Milton Keynes University Hospital, Milton Keynes MK6 5LD, United Kingdom
| | - Oliver Pearce
- Division of Trauma and Orthopaedics, Milton Keynes University Hospital, Milton Keynes MK6 5LD, United Kingdom
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17
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Ye T, Chen Z, Zhang J, Luo L, Gao R, Gong L, Du Y, Xie Z, Zhao B, Li Q, Wang Y. Large extracellular vesicles secreted by human iPSC-derived MSCs ameliorate tendinopathy via regulating macrophage heterogeneity. Bioact Mater 2023; 21:194-208. [PMID: 36101856 PMCID: PMC9440485 DOI: 10.1016/j.bioactmat.2022.08.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 07/19/2022] [Accepted: 08/08/2022] [Indexed: 11/05/2022] Open
Abstract
Tendinopathy is a common musculoskeletal disorder which results in chronic pain and reduced performance. The therapeutic effect of stem cell derived-small extracellular vesicles (sEVs) for tendinopathy has been validated in recent years. However, whether large extracellular vesicles (lEVs), another subset of extracellular vesicles, possesses the ability for the improvement of tendinopathy remains unknown. Here, we showed that lEVs secreted from iPSC-derived MSCs (iMSC-lEVs) significantly mitigated pain derived from tendinopathy in rats. Immunohistochemical analysis showed that iMSC-lEVs regulated the heterogeneity of infiltrated macrophages and several inflammatory cytokines in rat tendon tissue. Meanwhile, in vitro experiments revealed that the M1 pro-inflammatory macrophages were repolarized towards M2 anti-inflammatory macrophages by iMSC-lEVs, and this effect was mediated by regulating p38 MAPK pathway. Moreover, liquid chromatography-tandem mass spectrometry analysis identified 2208 proteins encapsulated in iMSC-lEVs, including 134 new-found proteins beyond current Vesiclepedia database. By bioinformatics and Western blot analyses, we showed that DUSP2 and DUSP3, the negative regulator of p38 phosphorylation, were enriched in iMSC-lEVs and could be transported to macrophages. Further, the immunomodulatory effect of iMSC-lEVs on macrophages was validated in explant tendon tissue from tendinopathy patients. Taken together, our results demonstrate that iMSC-lEVs could reduce inflammation in tendinopathy by regulating macrophage heterogeneity, which is mediated via the p38 MAPK pathway by delivery of DUSP2 and DUSP3, and might be a promising candidate for tendinopathy therapy. iMSC-lEVs significantly ameliorate tendinopathy both in a rat model and explant tendon tissue from human patient. iMSC-lEVs modulate macrophages polarization via p38 MAPK signaling pathway. Proteomics analysis of iMSC-lEVs discovers a new set of 134 proteins beyond current Vesiclepedia Database. The p38 MAPK signaling pathway-mediated macrophage repolarization was partly regulated by the delivery of DUSP2 and DUSP3. The immunoregulatory function of iMSC-lEVs are similar with iMSC-sEVs.
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18
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Abadin AA, Orr JP, Lloyd AR, Henning PT, Pourcho A. An Evidence-Based Approach to Orthobiologics for Tendon Disorders. Phys Med Rehabil Clin N Am 2023; 34:83-103. [DOI: 10.1016/j.pmr.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Hunter J, Spratford W, Fearon A, Bousie JA. Do posted foot orthoses alter hip biomechanics and pain during walking in women with greater trochanteric pain syndrome? Gait Posture 2023; 99:35-43. [PMID: 36327536 DOI: 10.1016/j.gaitpost.2022.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 06/14/2022] [Accepted: 10/20/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Greater trochanteric pain syndrome (GTPS), including gluteal tendinopathy and bursitis, is a common, painful and debilitating condition. It is thought to involve overload of the gluteal tendons, which may be amplified through increased hip adduction moment (HAM) seen during gait in these individuals. Reducing the aberrant HAM may improve pain and function in this population. We aimed to determine if medially-posted foot orthoses immediately reduce HAM and pain in females with GTPS during walking gait. METHODS A double-blind, repeated-measures trial with randomised intervention order compared three conditions in 53 women with GTPS. Participants acted as their own control during baseline (everyday-shoe insole), medially-posted (active) orthosis, or flat insert (sham orthosis) walking. Data were collected via three-dimensional gait analysis for HAM, hip, pelvic, and thorax kinematics; as well as ground reaction force; and pain via the numerical rating scale. Subgroup analysis was performed based on a pronated foot-posture defined by the Foot Posture Index. RESULTS A small pain reduction was found between the active orthosis and flat insert (mean difference = -0.444, p = 0.017). No difference was detected for pain between other condition comparisons. Thoracic lateral flexion increased at second-peak HAM between the baseline and active conditions (mean difference = -0.917, p = 0.040). No differences were detected for HAM, remaining kinematic or kinetic variables, or ground reaction force data across the three conditions. No significant differences were detected between any of the three conditions for biomechanical or pain data in the pronated-foot subgroup. SIGNIFICANCE A medially-posted foot orthosis did not immediately alter gait biomechanics or provide a clinically meaningful pain reduction in women with GTPS. There is uncertainty regarding the clinical benefit of orthoses in the management of GTPS. Longer-term follow-up or the use of customised orthoses may produce different outcomes and should be explored in future research.
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Affiliation(s)
- Jayden Hunter
- Discipline of Physiotherapy, Faculty of Health, University of Canberra, 11 Kirinari Street, Bruce, ACT 2617, Australia
| | - Wayne Spratford
- UCRISE, University of Canberra, 11 Kirinari Street, Bruce, ACT 2617, Australia
| | - Angie Fearon
- UCRISE, University of Canberra, 11 Kirinari Street, Bruce, ACT 2617, Australia
| | - Jaquelin A Bousie
- Discipline of Physiotherapy, Faculty of Health, University of Canberra, 11 Kirinari Street, Bruce, ACT 2617, Australia; UCRISE, University of Canberra, 11 Kirinari Street, Bruce, ACT 2617, Australia.
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Education plus exercise for persistent gluteal tendinopathy improves quality of life and is cost-effective compared with corticosteroid injection and wait and see: economic evaluation of a randomised trial. J Physiother 2023; 69:35-41. [PMID: 36526564 DOI: 10.1016/j.jphys.2022.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/15/2022] [Accepted: 11/28/2022] [Indexed: 12/15/2022] Open
Abstract
QUESTION For patients with gluteal tendinopathy, what is the cost utility from health system and societal perspectives of three management approaches: education plus exercise, ultrasound-guided corticosteroid injection or wait and see? DESIGN Economic evaluation alongside a three-group, parallel, randomised clinical efficacy trial. PARTICIPANTS People aged between 35 and 70 years with image-confirmed gluteal tendinopathy were recruited via advertisements. INTERVENTIONS Education plus exercise, consisting of 14 visits to a physiotherapist, with detailed instruction on tendinopathy management, twice weekly supervised exercise sessions, daily home exercises, a handout and a CD; corticosteroid injection, consisting of one ultrasound-guided injection and a handout on general tendon care; and 'wait and see', consisting of one visit to a physiotherapist with assurance and advice on staying active whilst respecting pain. OUTCOME MEASURES Economic outcome measures were quality-adjusted life years (QALYs) calculated from EuroQol EQ-5D-3L using Australian population preference weights, and total economic costs obtained from participant-reported data collected over the 1-year follow-up period. Missing data (<12% per group) were imputed. Linear regression was used to estimate incremental QALYs and costs between interventions; uncertainty was assessed by calculating 90% confidence intervals, cost-effectiveness acceptability curves and confidence ellipses. RESULTS A total of 204 individuals (82% women) were enrolled. Incremental cost-effectiveness ratio favoured education plus exercise over corticosteroid injection (AU$12,719 and $5,592 on societal and health system perspectives, respectively) and over wait and see ($29,258 and $3,444 on societal and health system perspectives, respectively). Complete case analysis and varying the direct intervention costs did not change the (imputed analysis) results, with the exception that corticosteroid injection was less cost-effective. CONCLUSION Education plus exercise for gluteal tendinopathy improves health-related quality of life and is cost-effective compared with corticosteroid injection and wait and see for treating gluteal tendinopathy. REGISTRATION ACTRN12612001126808.
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Mediators and Moderators of Education Plus Exercise on Perceived Improvement in Individuals With Gluteal Tendinopathy: An Exploratory Analysis of a 3-Arm Randomized Trial. J Orthop Sports Phys Ther 2022; 52:826-836. [PMID: 36306175 DOI: 10.2519/jospt.2022.11261] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE: To investigate mediators and moderators of effects of an education-plus-exercise program compared to corticosteroid injections or wait and see on perceived improvement in individuals with gluteal tendinopathy. METHODS: Exploratory analysis from a clinical trial (n = 204) comparing education plus exercise, corticosteroid injection, and wait and see on global rating of change at 52 weeks. Potential mediators measured at baseline and 8 weeks were hip active abduction range, abductor muscle torque, pain self-efficacy, pain constancy, and patient-specific function. Potential moderators at baseline were Victorian Institute of Sport Assessment for gluteal tendinopathy, menopausal status, symptom duration, magnetic resonance imaging-determined tendon pathology, and pain catastrophizing. RESULTS: There is evidence from mediation analysis that the beneficial effect of education plus exercise on global rating of change relative to corticosteroid injection or wait and see may be due to changes in patient-specific function (indirect effect relative risk; 95% CI: 1.14 [1.05-1.29], 1.29 [1.12-1.58], respectively), pain constancy (1.12 [1.03-1.27], 1.2 [1.08-1.41]), and pain self-efficacy (1.1 [1.02-1.25], 1.18 [1.04-1.44])-not active hip movement/muscle torque. Moderation analysis did not support our included patient characteristics. CONCLUSION: Education plus exercise is likely to improve global rating of change for persons with gluteal tendinopathy relative to corticosteroid injection and wait and see through improvements in patient-specific function, pain self-efficacy, and reduced pain constancy. We found no evidence of differences in the effect of education plus exercise in patient subgroups based on disability, menopausal status, symptom duration, tendon pathology, or pain catastrophizing. J Orthop Sports Phys Ther 2022;52(12):826-836. Epub: 17 October 2022. doi:10.2519/jospt.2022.11261.
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Andreasen J, Fearon A, Morissey D, Hjørnholm LH, Kristinsson J, Jorgensen JE, Mølgaard CM. "I feel I have been taken seriously" Women's experience of greater trochanteric pain syndrome treatment-A nested qualitative study. PLoS One 2022; 17:e0278197. [PMID: 36441745 PMCID: PMC9704619 DOI: 10.1371/journal.pone.0278197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 11/13/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Women experiencing greater trochanteric pain syndrome (GTPS) report high levels of pain and reduced quality of life. Exploring how they manage GTPS in a daily life context can provide important knowledge about individual coping strategies. Education, extracorporeal shockwave therapy (ESWT) and exercise have good group level evidence for efficacy in clinical trials and are increasingly used in routine care for patients with GTPS. Exploring women's experiences of such treatment may help understand the mechanisms underpinning these positive results and inform treatment strategies. We therefore aimed to explore how women with GTPS experience and manage their daily life, and their experience of the combined treatment of education, ESWT and exercises. METHODS This qualitative study was nested within a cohort study based in a hospital outpatient clinic and a physiotherapy clinic in Denmark assessing the combined treatment of education, ESWT and exercises. Data was collected from eleven women using in-person, individual, semi-structured interviews which were audio recorded. Transcripts were coded and analysed using an inductive thematic analysis approach. FINDINGS Five themes were identified: (1) Daily life was controlled and structured by pain; (2) The condition was acknowledged and taken seriously by treating professionals; (3) The participants´ experiences of the intervention-information is key; (4) Improved capability and autonomy in pain management and (5) The women´s perspectives on improving and expanding the intervention. Learning how to manage pain was experienced as the most important element of the program to the women to be able to minimize pain and manage daily life. CONCLUSION Exploration of how women with greater trochanteric pain syndrome experienced and managed daily hip pain, and how they experienced and adapted to treatment are important novel findings that will inform clinical practice. This new knowledge may be used to inform an individualized patient education, treatment and evaluation strategy for women with the painful and debilitating condition of GTPS.
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Affiliation(s)
- Jane Andreasen
- Department of Physiotherapy and Occupational Therapy, Aalborg University Hospital, Aalborg, Denmark,The Faculty of Medicine, Department of Health Science and Technology, Public Health and Epidemiology Group, Aalborg University, Aalborg, Denmark,* E-mail:
| | - Angela Fearon
- UCRISE, Faculty of Health, University of Canberra Hospital, University of Canberra, Bruce ACT, Australia
| | - Dylan Morissey
- Sport and Exercise Medicine, Queen Mary University of London, London, United Kingdom,Physiotherapy Department, Barts Health NHS Trust, London, United Kingdom
| | - Laura H. Hjørnholm
- Department of Physiotherapy and Occupational Therapy, Aalborg University Hospital, Aalborg, Denmark
| | - Jens Kristinsson
- Department of Orthopaedic Surgery, Aalborg University Hospital, Aalborg, Denmark
| | | | - Carsten M. Mølgaard
- Department of Physiotherapy and Occupational Therapy, Aalborg University Hospital, Aalborg, Denmark,Sport and Exercise Medicine, Queen Mary University of London, London, United Kingdom,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Comparative Efficacy of Nonoperative Treatments for Greater Trochanteric Pain Syndrome: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials. Clin J Sport Med 2022; 32:427-432. [PMID: 34009798 DOI: 10.1097/jsm.0000000000000924] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 01/20/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE An evolved understanding of the pathophysiology of greater trochanteric pain syndrome has led to a number of proposed nonoperative management strategies. The objective of this review was to compare the efficacy of the various nonoperative treatments for greater trochanteric pain syndrome (GTPS). DESIGN Systematic review and network meta-analysis. SETTING PubMed, Embase, CENTRAL, SCOPUS, and Web of Science were searched to January 2020. PATIENTS Patients undergoing nonoperative treatment for GTPS. INTERVENTIONS Nonoperative treatment strategies for GTPS including injections of corticosteroids, platelet-rich plasma, hyaluronic acid, dry needling, and structured exercise programs and extracorporeal shockwave therapy. MAIN OUTCOME MEASURES Pain and functional outcomes. Bayesian random-effects model was performed to assess the direct and indirect comparison of all treatment options. RESULTS Thirteen randomized controlled trials and 1034 patients were included. For pain scores at 1 to 3 months follow-up, both platelet-rich plasma (PRP) and shockwave therapy demonstrated significantly better pain scores compared with the no treatment control group with PRP having the highest probability of being the best treatment at both 1 to 3 months and 6 to 12 months. No proposed therapies significantly outperformed the no treatment control group for pain scores at 6 to 12 months. Structured exercise had the highest probability of being the best treatment for improvements in functional outcomes and was the only treatment that significantly improved functional outcome scores compared with the no treatment arm at 1 to 3 months. CONCLUSION Current evidence suggests that PRP and shockwave therapy may provide short-term (1-3 months) pain relief, and structured exercise leads to short-term (1-3 months) improvements in functional outcomes.
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Dzidzishvili L, Parrón Cambero R, Mahillo Fernández I, Llanos Jiménez L. Prognostic factors of trochanteric bursitis in surgical-staged patients: a prospective study. Hip Int 2022; 32:530-536. [PMID: 33428860 DOI: 10.1177/1120700020986136] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Trochanteric bursitis or greater trochanteric pain syndrome is a common disorder and frequent cause of lateral hip pain. It can lead to severe functional impairment with increase morbidity and poor quality of life.The purpose of the current study was to identify and evaluate relationship between health-related factors, as prognostic indicators, and clinical outcomes. METHODS A single-centre, prospective study was conducted and 60 patients (62 hips) were included with a minimum 12 months of follow-up. Clinical outcomes were evaluated using Hip Outcome Scale, Single Assessment Numeric Evaluation and Visual Analogue Scale. Radiological assessments and health-related factors were documented in an attempt to understand their validity as predictors of clinical outcomes. Complications and recurrence rates were also analyzed. RESULTS Univariate model revealed that an increased BMI (p = 0.001; OR = 1.05; 95% CI, 1.02-1.07); number of previous corticosteroid infiltrations (p = 0.001; OR = 1.28, 95% CI, 1.11-1.48); longer time from symptom onset to surgery (p = 0.001; OR = 1.19; 95% CI, 1.12-1.28); smoker status (p = 0.001; OR 11.2; 95% CI, 3.30-44.2); and the presence of prior lumbosacral fusion (LSF) (p = 0.001; OR 13.8; 95% CI, 2.96-101); were prognostic factors predisposing for poor clinical outcomes.Among prognostic health-related factors were medical comorbidities such as emotional distress (p < 0.001; OR 26.1; 95% CI, 5.71-192); fibromyalgia (p = 0.026; OR 3.56; 95% CI, 1.16-11.7); and hyporthyroidism (p = 0.005, OR = 6.55, 95% CI, 1.73-28.7). CONCLUSIONS Better overall physical function was predicted by lower number of corticosteroid infiltrations, shorter time span from symptom onset to surgery, non-smoker status and the absence of prior lumbosacral fusion. Obesity, smoking, the presence of emotional distress, fibromyalgia and hypothyroidism seem to increase the risk of poor clinical outcomes. A proper selection and/or correction of modifiable prognostic factors could reduce the incidence of endoscopic treatment failure and, as a consequence, improve patient outcomes and quality of life. However, future efforts should focus on experimental and randomised studies to fully determine these associations.
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Affiliation(s)
- Lika Dzidzishvili
- Department of Orthopaedic Surgery, Hip and Knee Replacement Unit, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Raúl Parrón Cambero
- Department of Orthopaedic Surgery, Hip and Knee Replacement Unit, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Ignacio Mahillo Fernández
- Biostatistics and Epidemiology Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Lucía Llanos Jiménez
- Clinical Research Unit, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
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Thomaz de Aquino Nava G, Baldini Prudencio C, Krasic Alaiti R, Mendes Tozim B, Mellor R, Rodrigues Pedroni C, Mércia Pascon Barbosa A, Tavella Navega M. Motor control exercises versus general exercises for greater trochanteric pain syndrome: A protocol of a randomized controlled trial. PLoS One 2022; 17:e0269230. [PMID: 35749349 PMCID: PMC9231741 DOI: 10.1371/journal.pone.0269230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 05/12/2022] [Indexed: 12/03/2022] Open
Abstract
Introduction Greater trochanteric pain syndrome is an overarching term used to define pain and tenderness in the greater trochanteric region of the femur, which is more common in women. Abnormal control of lower limb movements and deficient neuromuscular parameters may lead to greater trochanteric pain syndrome; however, no studies have used neuromuscular training as a treatment strategy. Thus, this study aims to compare the effect of a protocol of general exercises versus a program of motor control training on pain at baseline and after treatment in women with greater trochanteric pain syndrome. Methods The study was approved by the Research Ethics Committee (CAAE: 87372318.1.0000.5406) and has been prospectively registered on the Brazilian Registry of Clinical Trials (RBR-37gw2x). Sixty participants will be randomized to receive motor control exercises or general exercises. The application will be performed twice a week for 8 weeks. The participants will be evaluated before the treatment (T0), after 8 weeks of intervention (T8) and after 60 weeks of intervention (T60). The primary outcome measures will be the hip pain intensity, and secondary outcomes will be muscle strength, kinesiophobia, global perceived effect, pain catastrophization, central sensitization and quality of life. Conclusions Studies have suggested that greater trochanteric pain syndrome may be related to poor hip and pelvic control, however, no study has investigated an exercise protocol focused on increasing the strength of the abductor and extensor muscles of the hip associated with pelvic control training, especially in positions of unilateral support, such as gait. This study will help determine whether greater trochanteric pain syndrome is related to abnormal control of lower limb movements.
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Affiliation(s)
- Guilherme Thomaz de Aquino Nava
- Department of Physical Education, Institute of Biosciences, São Paulo State University (UNESP), Rio Claro, São Paulo, Brazil
- * E-mail:
| | - Caroline Baldini Prudencio
- Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Rafael Krasic Alaiti
- Nucleus of Neuroscience and Behavior and Nucleus of Applied Neuroscience, Universidade de São Paulo (USP), São Paulo, Brazil
| | - Beatriz Mendes Tozim
- Department of Physiotherapy and Occupational Therapy, Faculty of Philosophy and Sciences, São Paulo State University (UNESP), Marilia, São Paulo, Brazil
| | - Rebecca Mellor
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Cristiane Rodrigues Pedroni
- Department of Physical Education, Institute of Biosciences, São Paulo State University (UNESP), Rio Claro, São Paulo, Brazil
- Department of Physiotherapy and Occupational Therapy, Faculty of Philosophy and Sciences, São Paulo State University (UNESP), Marilia, São Paulo, Brazil
| | - Angélica Mércia Pascon Barbosa
- Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
- Department of Physiotherapy and Occupational Therapy, Faculty of Philosophy and Sciences, São Paulo State University (UNESP), Marilia, São Paulo, Brazil
| | - Marcelo Tavella Navega
- Department of Physical Education, Institute of Biosciences, São Paulo State University (UNESP), Rio Claro, São Paulo, Brazil
- Department of Physiotherapy and Occupational Therapy, Faculty of Philosophy and Sciences, São Paulo State University (UNESP), Marilia, São Paulo, Brazil
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A Cutaneous Transposition Inversion Flap to Treat Symptomatic Subcutaneous Trochanteric or Soft Tissue Defects After Hip Arthroplasty: A Technical Note. Tech Orthop 2022. [DOI: 10.1097/bto.0000000000000591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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27
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Arvesen J, McCallum J, Pill SG, Cannady H, Adams KJ, Jackson I, Wienke JR, Folk J. Prevalence of Contralateral Hip Abductor Tears and Factors Associated With Symptomatic Progression. Am J Sports Med 2022; 50:1603-1608. [PMID: 35507471 DOI: 10.1177/03635465221083671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patients with gluteus medius tendinopathy present with laterally based hip pain that can be diagnosed under the greater trochanteric pain syndrome diagnosis. Magnetic resonance imaging (MRI) can assist in diagnosing pathology of the symptomatic hip, and when a pelvic MRI that includes both hips, the clinician may identify asymptomatic tears in the nonsurgical hip. In patients who undergo unilateral gluteus medius repairs, little is known about the prevalence or subsequent onset of clinical symptoms in the nonsurgical hip. PURPOSE To describe (1) the prevalence of asymptomatic contralateral gluteus medius tears in patients with unilateral symptoms, (2) the presentation and time before symptom onset, and (3) the morphological characteristics on MRI of future symptomatic tears. STUDY DESIGN Case series; Level of evidence, 4. METHODS A total of 51 consecutive patients who underwent gluteus medius tear surgery were reviewed for contralateral hip pathology; of these, 43 patients were 2 years out from index surgery with reviewable preoperative MRI scans. A musculoskeletal radiologist reviewed the MRI scans for tear size, tendon retraction, and fatty infiltration using the Goutallier-Fuchs grading system. Medical record review identified contralateral hips requiring subsequent treatment. RESULTS Of the original 43 patients, 10 (23%) had no contralateral tear, 19 (44%) had low-grade partial tears, 9 (20%) had high-grade partial tears, and 5 (11%) had full-thickness tears. Thirty-seven patients had unilateral symptoms; the other 6 had mild contralateral hip pain at enrollment. Of the 37 patients with unilateral symptoms, 27 (73%) had a contralateral tear; of those, 10 became symptomatic at an average of 24 months after index presentation (range, 6-50 months). In patients with symptomatic progression, 7 had low-grade partial tears, 1 had a high-grade partial tear, and 2 had full-thickness tears, with an average retraction of 17 mm. Tendon tear grade on MRI did not always correlate with symptoms or future presentation. All symptomatic progression remained mild to moderate. Seven patients required a corticosteroid injection, and none needed contralateral hip surgery within 2 years. CONCLUSION Of patients who underwent surgery for a gluteus medius tear, 73% (27/37) had an incidental MRI-confirmed contralateral hip abductor tear. Of these, 37% (10/27) developed symptoms consistent with greater trochanteric pain syndrome during the 2-year study period.
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Affiliation(s)
- John Arvesen
- Steadman Hawkins Clinic of the Carolinas, Prisma Health-Upstate, Greenville, South Carolina, USA
| | - Jeremy McCallum
- Steadman Hawkins Clinic of the Carolinas, Prisma Health-Upstate, Greenville, South Carolina, USA
| | - Stephan G Pill
- Steadman Hawkins Clinic of the Carolinas, Prisma Health-Upstate, Greenville, South Carolina, USA
| | | | - Kyle J Adams
- Hawkins Foundation, Greenville, South Carolina, USA
| | | | - Jeffrey R Wienke
- Department of Radiology, Prisma Health-Upstate, Greenville, South Carolina, USA
| | - Jason Folk
- Steadman Hawkins Clinic of the Carolinas, Prisma Health-Upstate, Greenville, South Carolina, USA
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Høgsholt M, Jørgensen SL, Rolving N, Mechlenburg I, Tønning LU, Bohn MB. Exercise With Low-Loads and Concurrent Partial Blood Flow Restriction Combined With Patient Education in Females Suffering From Gluteal Tendinopathy: A Feasibility Study. Front Sports Act Living 2022; 4:881054. [PMID: 35498515 PMCID: PMC9047753 DOI: 10.3389/fspor.2022.881054] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 03/23/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction To date, there exists no gold standard conservative treatment for lateral hip pain due to tendinopathy of the gluteus medius and/or minimus tendon (GT), a condition often complicated by pain and disability. Higher loads during everyday activities and exercise seems to be contraindicated with GT. The purpose of this study was to evaluate the feasibility of exercise with low-loads concurrent partial blood flow restriction (LL-BFR) and patient education for patients present GT. Methods Recruitment took place at three hospitals in the Central Denmark Region. The intervention consisted of daily sessions for 8 weeks with one weekly supervised session. From week three patients exercised with applied partial blood flow restriction by means of a pneumatic cuff around the proximal thigh of the affected leg. Throughout the intervention patients received patient education on their hip condition. Sociodemographic and clinical variables were collected at baseline. The feasibility of LL-BFR was conducted by adherence to the exercise protocol and drop-out rate. Patient reported outcome measures (The Victorian Institute of Sport Assessment-Gluteal Questionnaire, EuroQol - 5 Dimensions-Visual Analogue Scale, Oxford Hip Score, Copenhagen Hip and Groin Outcome Score), maximal voluntary isometric hip abduction-, hip extension, and knee extension strength (Nm/kg) measured using a handheld dynamometer, and functional capacity tests (30 second chair-stand test and a stair-climb test) was conducted as secondary outcomes. Results Sixteen women with a median (IQR) age of 51 (46–60) years were included. Median (IQR) Body Mass Index was 26.69 (23.59–30.46) kg/m2. Adherence to the total number of training sessions and the LL-BFR was 96.4 and 94.4%, respectively. Two patients dropped out due to (i) illness before initiation of LL-BFR and (ii) pain in the affected leg related to the LL-BFR-exercise. At follow-up both pain levels and patient-reported outcome measures improved. Isometric hip abduction-, hip extension-, and knee extension strength on both legs and functional performance increased. Conclusion: LL-BFR-exercise seems feasible for treatment of GT. At follow-up, a high adherence and low drop-out rate were observed. Further, patients reported clinically relevant reductions in pain, and showed significant increases in isometric hip and knee strength.
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Affiliation(s)
- Mathias Høgsholt
- Department of Occupational and Physical Therapy, Horsens Regional Hospital, Horsens, Denmark
| | - Stian Langgård Jørgensen
- Department of Occupational and Physical Therapy, Horsens Regional Hospital, Horsens, Denmark
- H-HIP, Department of Orthopedic Surgery, Horsens Regional Hospital, Horsens, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Nanna Rolving
- Center of Rehabilitation Research, DEFACTUM, Central Denmark Region, Aarhus, Denmark
- Department of Physical and Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Inger Mechlenburg
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Orthopedic Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Lisa Urup Tønning
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Orthopedic Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Marie Bagger Bohn
- H-HIP, Department of Orthopedic Surgery, Horsens Regional Hospital, Horsens, Denmark
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Nasser AM, Fearon AM, Grimaldi A, Vicenzino B, Mellor R, Spencer T, Semciw AI. Outcome measures in the management of gluteal tendinopathy: a systematic review of their measurement properties. Br J Sports Med 2022; 56:877-887. [PMID: 35396205 DOI: 10.1136/bjsports-2021-104548] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Evaluate properties of outcome measures for gluteal tendinopathy. DESIGN Multistage scoping/systematic review. DATA SOURCES Cochrane, PubMed, Embase, Scopus, Web of Science, PEDro, CINAHL, SPORTDISCUS were searched (December 2021) to identify measures used to evaluate gluteal tendinopathy. Measures were mapped to the core health domains for tendinopathy. Medline, CINAHL, Embase and PubMed were searched (December 2021) for studies evaluating measurement properties of gluteal tendinopathy outcome measures captured in the initial search. Both reviews included studies that evaluated a treatment in participants with gluteal tendinopathy, diagnosed by a professional. Consensus-based-Standards for the Selection of Health Instruments methodology were followed-including bias assessment and synthesis of findings. RESULTS Six studies reported on the Victorian Institute of Sport Assessment-Gluteal Tendinopathy (VISA-G). One study reported on the Hip Outcome Score (HOS)-activities of daily living (ADL) and Sport.The VISA-G had moderate-quality evidence of sufficient construct validity (known group) and responsiveness (pre-post intervention), low-quality evidence of sufficient reliability, measurement error, comprehensibility and insufficient construct validity (convergent), and very low-quality evidence of sufficient comprehensiveness, relevance and responsiveness (comparison with other outcome measures).Both the HOS(ADL) and HOS(Sport) had very low-quality evidence of sufficient reliability, relevance and insufficient construct validity and comprehensiveness. The HOS(ADL) had very low-quality evidence of sufficient comprehensibility and insufficient measurement error. The HOS(Sport) had very low quality evidence of inconsistent comprehensibility and sufficient measurement error. CONCLUSION Rigorously validated outcome measures for gluteal tendinopathy are lacking. The VISA-G is the preferred available option to capture the disability associated with gluteal tendinopathy.
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Affiliation(s)
- Anthony M Nasser
- School of Allied Health, La Trobe University, Melbourne, Victoria, Australia .,Graduate School of Health, University of Technology, Sydney, New South Wales, Australia
| | - Angela M Fearon
- Discipline of Physiotherapy, Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia.,Trauma and Orthopaedic Research Unit, Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Alison Grimaldi
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Bill Vicenzino
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Rebecca Mellor
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Trevor Spencer
- Discipline of Physiotherapy, Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia.,Trauma and Orthopaedic Research Unit, Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Adam Ivan Semciw
- School of Allied Health, La Trobe University, Melbourne, Victoria, Australia.,Allied Health, Northern Health, Melbourne, Victoria, Australia
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Bateman D, Wang M, Mennona S, Kayiaros S. Incidence of and Risk Factors for Lateral Trochanteric Pain After Direct Anterior Approach Total Hip Arthroplasty. Orthopedics 2022; 45:e79-e85. [PMID: 34978513 DOI: 10.3928/01477447-20211227-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Lateral trochanteric pain (LTP) is a common complication after total hip arthroplasty (THA). The goals of this study were to report the incidence of LTP after direct anterior approach (DAA) THA, describe the treatment course and outcomes, and examine patient-specific and implant-related potential risk factors. A retrospective review identified patients who underwent primary DAA THA with at least 1-year follow-up. Postoperative functional outcome scores and LTP occurrence were recorded. Patient demographics, surgical indications, implant characteristics, medical comorbidities, and radiographic parameters were obtained. Logistic regression analysis was used to identify risk factors. A total of 610 THA procedures were performed for 563 patients (mean follow-up, 30.9±15.2 months). The overall incidence of LTP was 11.6%. All cases of LTP were successfully treated conservatively, although these patients, compared with patients who did not have postoperative LTP, experienced significantly lower functional outcome scores (Harris Hip Score, 96.6±4.7 [range, 55-100] vs 89.9±8.5 [range, 42-100], respectively; P<.001). Logistic regression analysis identified female sex (odds ratio, 2.30; 95% CI, 1.32-4.02), diabetes mellitus (odds ratio, 2.32; 95% CI, 1.11-4.88), hypertension (odds ratio, 1.94; 95% CI, 1.15-3.28), and the use of an offset acetabular liner (odds ratio, 2.50; 95% CI, 1.06-5.91) as independent risk factors for LTP. There was no correlation between LTP and radiographic parameters. The incidence of LTP after DAA THA is similar to reported rates for other THA surgical approaches. Female sex, medical comorbidities, and the use of offset acetabular liners are likely associated, and patients should be counseled appropriately. Postoperative LTP results in worse functional outcomes, although all cases can be treated conservatively. [Orthopedics. 2022;45(2):e79-e85.].
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Modelling gluteus medius tendon degeneration and repair in a large animal model. Arch Orthop Trauma Surg 2022; 142:1-12. [PMID: 32813126 DOI: 10.1007/s00402-020-03573-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 08/02/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Gluteus medius tendon tears often occur in the context of chronic tendinopathy and remain a difficult clinical problem. Surgical repair is challenging as it is often delayed and performed in degenerative tendons. No animal model currently exists to mimic the delayed repair of tendinopathic gluteus medius tears. The aims of this study were to develop a chronic model of gluteus medius tendinopathy and tear and then compare this model to an acute gluteus medius tear and repair. MATERIALS AND METHODS Six gluteus medius muscles were dissected and examined in mature sheep to confirm anatomical similarity to the human counterpart. Ten separate adult sheep underwent tendon detachment, followed by relook and histological sampling at 6 and 16 weeks to assess the extent of tendon degeneration. Six adult sheep underwent tendon repair at 6 weeks and were later assessed for healing of the tendon and compared to a further four adult sheep who underwent an acute tendon detachment and repair procedure. RESULTS The sheep gluteus medius muscle consisted of three compartments, the anterior, middle and posterior. All compartments inserted via the common tendon on the superolateral aspect of the greater trochanter. At both 6 and 16 weeks, there was significant tendinopathic changes on histology compared to controls as assessed by modified Movin's score (p = 0.018, p = 0.047) but no difference between the 6- and 16-week groups (p = 0.25). There were significant differences between delayed and acute repair in both histological appearance (p = 0.025) and biomechanical properties (p = 0.019), with acute repair superior in both. CONCLUSIONS Tendon detachment for 6 weeks is sufficient to produce histological changes similar to chronic tendinopathy and repair of this degenerative tendon results in significantly poorer healing when compared to an acute repair model. Animal models for gluteus medius tears should use a delayed repair model to improve clinical validity.
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Bicket L, Cooke J, Knott I, Fearon A. The natural history of greater trochanteric pain syndrome: an 11-year follow-up study. BMC Musculoskelet Disord 2021; 22:1048. [PMID: 34930192 PMCID: PMC8691027 DOI: 10.1186/s12891-021-04935-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 12/03/2021] [Indexed: 12/04/2022] Open
Abstract
Background Greater trochanteric pain syndrome (GTPS) is a musculoskeletal condition which can cause disability and reduce quality of life. However, limited evidence is available on the long-term outcomes of people with GTPS. Our aims were to determine the long-term prevalence of GTPS; to calculate the proportion of people with GTPS who had developed hip osteoarthritis (OA); and to determine the level of function and quality of life, 11-years after initial GTPS diagnosis. Methods A prospective 11-year natural history study. Two groups [GTPS group (n = 24), asymptomatic control (ASC) group (n = 20)] were evaluated at baseline, 12-months and 11-years. At 11-years all participants completed the modified Harris Hip Score (mHHS), Oswestry Disability Index (ODI) and Assessment of Quality-of-Life questionnaire. At 11-year follow-up 20/24 GTPS and 19/20 ASC participants were clinically assessed for GTPS and hip OA, completed the 10 metre-walk-test, timed up and go, and hip abduction and external rotation strength testing. Results At 11-year follow-up 45.0% of GTPS participants had GTPS compared to 5.3% of ASC participants (p = 0.008), OR [95% CI]: 10.19 [1.95, 104.3], and 35.0% of GTPS participants were clinically diagnosed with hip OA compared to none of the ASC participants (p = 0.002), OR [95% CI]: 21.6, [2.3, 2898.0]. GTPS participants reported more pain and disability than ASC participants via the ODI, mean difference [95% CI]: 6.1 [0.7, 11.6] but not the modified Harris Hip Score, mean difference [95% CI]: -3.3 [-10.3, 3.7]. Both groups had similar levels of quality of life and measures of function. Conclusions GTPS is a chronic condition: people with GTPS at baseline had twice the odds of being clinically diagnosed with GTPS or hip OA than the control group at 11-years. Further, there appears to be a temporal relationship between GTPS and the development of hip OA. This finding highlights the need to identify effective treatments that address the underlying impairments associated with GTPS. Pain and function results varied depending on the assessment tools used. Between group differences in quality of life seen at baseline are not found at the 11-year follow-up. The small sample size means the results must be considered with caution. Level of Evidence Level II Natural history Study. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04935-w.
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Affiliation(s)
- Luke Bicket
- Faculty of Health, University of Canberra, 11 Kirinari St, Bruce, ACT, 2617, Australia
| | - Julie Cooke
- Faculty of Health, University of Canberra, 11 Kirinari St, Bruce, ACT, 2617, Australia.,Research Institute for Sport and Exercise, University of Canberra, 11 Kirinari St, Bruce, ACT, 2617, Australia
| | - Isaac Knott
- Canberra Health Services, 20 Guraguma St, Bruce, 2617, Australia
| | - Angie Fearon
- Faculty of Health, University of Canberra, 11 Kirinari St, Bruce, ACT, 2617, Australia. .,Research Institute for Sport and Exercise, University of Canberra, 11 Kirinari St, Bruce, ACT, 2617, Australia. .,Trauma and Orthopaedic Research Centre at the Canberra Hospital, Garren, ACT, 2606, Australia.
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Moerenhout K, Benoit B, Gaspard HS, Rouleau DM, Laflamme GY. Greater trochanteric pain after primary total hip replacement, comparing the anterior and posterior approach: A secondary analysis of a randomized trial. Orthop Traumatol Surg Res 2021; 107:102709. [PMID: 33132093 DOI: 10.1016/j.otsr.2020.08.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 08/11/2020] [Accepted: 08/17/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Greater trochanteric pain (GTP) after total hip replacement is a common cause of residual lateral hip pain, regardless of the approach used. The goal of our study was to evaluate GTP after a direct anterior approach (DAA) compared to a posterior approach (PA) as well as the clinical outcomes of both approaches and answer the following: 1) What is the incidence of trochanteric pain after primary THA with two different surgical approaches? 2) What is the functional outcome of patients with GTP? 3) What proportion of patients with GTP resort to peritrochanteric injections? HYPOTHESIS Our hypothesis is that GTP is present with both approaches but satisfaction is lower with the PA. PATIENTS AND METHODS A secondary analysis of a previously published clinical trial with 55 total hip arthroplasty patients randomized in one of two surgical approaches: 27 patients underwent the anterior modified Hueter approach, while the other group of 28 patients were operated using the posterior approach. Study outcomes were Modified Harris Hip Score (MHHS), satisfaction score, pain when lying on the affected side, and requiring an injection. Hip offset, femur lateralization and leg lengthening were measured before and after surgery. RESULTS Forty-five patients were available for complete follow-up at a mean of 62 months (range: 48-74). The incidence of GTP was higher in the posterior approach [PA: 6/21 (29%) vs DAA 4/24 (17%)) (p=0.3). Patients operated through a PA experienced more pain [5/21 (24%) of patients; VAS=mean 5.3] when lying on their operated side, compared to DAA patients [2/24 (8%) of patients; VAS=mean 2) (p=0.2)]. However, MHHS, patient satisfaction with surgery, radiological assessment for hip offset, femur lateralization or leg lengthening, and injections required were similar for both approaches. Overall, satisfaction and functional outcome with surgery was significantly lower in GTP patients, regardless of the approach. CONCLUSIONS GTP impacts patient satisfaction and functional outcome in total hip arthroplasty patients. PA patients reported more trochanteric pain than DAA patients, which affected their clinical outcome. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Kevin Moerenhout
- Orthopedic Surgery, Department of Surgery, Hôpital Sacré-Cœur de Montréal, 5400 boulevard Gouin O., H4J 1C5 Montréal, Québec, Canada; Department of Orthopaedics and Traumatology, Lausanne University Hospital, rue du Bugnon 46, CH-1011 Lausanne, Switzerland.
| | - Benoit Benoit
- Orthopedic Surgery, Department of Surgery, Hôpital Sacré-Cœur de Montréal, 5400 boulevard Gouin O., H4J 1C5 Montréal, Québec, Canada
| | - Henry S Gaspard
- Orthopedic Surgery, Hull Hospital, 116, boulevard Lionel-Émond, J8Y 1W7 Gatineau, Québec, Canada
| | - Dominique M Rouleau
- Orthopedic Surgery, Department of Surgery, Hôpital Sacré-Cœur de Montréal, 5400 boulevard Gouin O., H4J 1C5 Montréal, Québec, Canada
| | - G Yves Laflamme
- Orthopedic Surgery, Department of Surgery, Hôpital Sacré-Cœur de Montréal, 5400 boulevard Gouin O., H4J 1C5 Montréal, Québec, Canada
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Analgesic effects of low-dose radiotherapy in greater trochanteric pain syndrome: results in a clinical series of 155 patients with recurrent or refractory symptoms. Clin Transl Oncol 2021; 24:846-853. [PMID: 34807401 DOI: 10.1007/s12094-021-02730-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 10/30/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE This prospective study assessed the effects of low-dose radiotherapy in patients diagnosed with greater trochanteric pain syndrome (GTPS) with recurrent symptoms or refractory to previous conservative measures. METHODS We evaluated a total of 155 patients (90.3% women, mean age 69 years). Most patients (n = 136) received 10 Gy (1 Gy/day/3 fractions per week on alternate days), but after recommendations of DEGRO guidelines published in 2015, the remaining 19 patients (12.2%) received 6 Gy (1 Gy/day/3 fractions per week on alternate days). RESULTS At the pre-treatment visit, the mean (standard deviation, SD) visual analog scale (VAS) score was 8), which decreased to 5 (SD 2.2) after 1 month of the end of treatment and to 4 (SD 2.3) after 4 months. An objective symptom response with increased mobility, better sleep quality, and reduction of analgesic medication was found in 56% of patients at 1 month. In 129 patients (83.2%), there was a decrease of at least 1 point in the VAS score, and in 49 patients (29.0%), the VAS score was lower than 3. The mean length of follow-up was 45 months. The probability of maintaining the analgesic response estimated by the Kaplan-Meier method was 53% at 5 years. CONCLUSION Low dose radiotherapy effectively improved pain in the trochanteric area in most patients with recurrent or refractory GTPS, allowing a reduction in the need for analgesic medications and, more, importantly, better functioning and mobility. Further randomized studies in selected populations of GTPS are needed to define the treatment position of low-dose radiotherapy in this clinical setting.
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Heaver C, Pinches M, Kuiper JH, Thomas G, Lewthwaite S, Burston BJ, Banerjee RD. Greater trochanteric pain syndrome: focused shockwave therapy versus an ultrasound guided injection: a randomised control trial. Hip Int 2021; 33:490-499. [PMID: 34784804 DOI: 10.1177/11207000211060396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Greater trochanteric pain syndrome (GTPS) is a common problem with an incidence of 1.8-5.6 per 1000 population. Physiotherapy, anti-inflammatories, corticosteroid injections and surgery have all been described in the management of GTPS, with limited, temporal success. Extracorporeal shockwave therapy (ESWT) has been proposed as a potential non-invasive management option for this difficult presentation. METHOD We ran a prospective, 2-arm, single-blinded, randomised control trial comparing focused shockwave therapy (f-ESWT) to an ultrasound guided corticosteroid injection. Primary outcome measure was the visual analogue pain score. Secondary outcome measures included the Harris Hip Score (HHS) and Trendelenburg test for function; SF-36 for quality of life (QoL); and a Likert scale question for subjective assessment of symptom improvement. RESULTS 104 patients (10 males and 94 females), of mean age 61.5 years were recruited. 53 were randomised to receive ESWT and 51 to receive an image-guided injection. 11 patients were lost to follow-up. There were no significant differences in baseline scores between groups.At 3 months, pain, function and QoL scores had improved in both groups but were not statistically significant. The Trendelenburg test was significantly improved in the f-ESWT group with 80% patients being negative compared to 20% at baseline (p < 0.001).At 12 months, across all outcomes, the ESWT group had significantly improved scores compared to the injection group; VAS 37.1 versus 55.0 (p = 0.007, 95% confidence interval [CI], 6.3-30.8), HHS 69.7 versus 57.5 (p = 0.002, 95% CI, -20.0 to -4.6) and SF-36 52.4 versus 47.7 (p = 0.048, 95% CI, -9.31 to -0.04). The improvement in Trendelenburg test was maintained in the ESWT group, but the injection group had reverted to baseline (p < 0.001). CONCLUSIONS We have shown f-ESWT is an effective treatment for patients with GTPS. We would advocate f-ESWT as an effective non-invasive treatment modality for this challenging patient population.Trial Registration No. ISRCTN8338223.
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Affiliation(s)
- Catriona Heaver
- Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, UK
| | - Megan Pinches
- Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, UK
| | - Jan Herman Kuiper
- Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, UK.,Keele University, Keele, Staffordshire, UK
| | - Geraint Thomas
- Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, UK.,Keele University, Keele, Staffordshire, UK
| | | | - Ben J Burston
- Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, UK
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Quantitative MRI in patients with gluteal tendinopathy and asymptomatic volunteers: initial results on T1- and T2*-mapping diagnostic accuracy and correlation with clinical assessment. Skeletal Radiol 2021; 50:2221-2231. [PMID: 33914122 DOI: 10.1007/s00256-021-03781-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 04/04/2021] [Accepted: 04/04/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine if T1- and T2*-mapping of the gluteal tendons can discriminate between participants with and without clinical findings of gluteal tendinopathy (GT) and if they correlate with clinical assessment. MATERIALS AND METHODS This prospective study was conducted between January and December 2016. MRI of the hip included spin echo, short-T1 inversion recovery, variable-flip angle, and variable echo-time gradient echo sequences. MRI studies were reviewed independently by two radiologists. Two other readers segmented the gluteal tendons and T1, mono- (T2*m) and bi-exponential T2* (short (T2*s) and long (T2*l) components) were computed. RESULTS Ten participants with GT (median age; interquartile range: 63 (57-67) years, all women) and 9 participants without GT (57 (55-59) years, 8 women) (P = 0.06) were enrolled. The sensitivity and specificity of reader 1 for disease classification were 40% (95% confidence interval (CI): 17-61%) and 70% (CI: 47-91%), and those of reader 2 were 70% (CI: 43-86%) and 80% (CI: 53-96%), with fair inter-reader agreement (Kappa = .38). T1 values could not discriminate between the two groups. The gluteal tendons T2*m and T2*s showed diagnostic accuracy ranging from .80 to .89. The posterior gluteus medius tendon T2*m and T2*s respectively showed sensitivity and specificity of 90%, and strong correlation (Spearman's rho = -.71; P = 0.02) with the Lower Extremity Functional Scale score. CONCLUSION Quantitative MRI could help gain new insight into healthy and diseased gluteal tendons to allow better diagnosis and treatment stratification for patients.
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Migliorini F, Kader N, Eschweiler J, Tingart M, Maffulli N. Platelet-rich plasma versus steroids injections for greater trochanter pain syndrome: a systematic review and meta-analysis. Br Med Bull 2021; 139:86-99. [PMID: 34405857 DOI: 10.1093/bmb/ldab018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 07/17/2021] [Accepted: 07/20/2021] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Greater trochanter pain syndrome (GTPS) is characterized by a persistent and debilitating pain around the greater trochanter. GTPS can be caused by a combination of gluteus medius or minimus tendinopathy, snapping hip or trochanteric bursitis. SOURCE OF DATA Recent published literatures identified from PubMed, EMBASE, Google Scholar, Scopus. AREAS OF AGREEMENT Platelet rich plasma (PRP) and corticosteroids (CCS) injections are useful options to manage symptoms of GTPS. AREAS OF CONTROVERSY Whether PRP leads to superior outcomes compared to CCS injections is unclear. GROWING POINTS A systematic review and meta-analysis comparing PRP versus CCS in the management of GTPS was conducted. AREAS TIMELY FOR DEVELOPING RESEARCH PRP injections are more effective than CCS at approximately 2 years follow-up.
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Affiliation(s)
- Filippo Migliorini
- Department of Orthopedic, Trauma, and Reconstructive Surgery, RWTH University Hospital of Aachen, 52074 Aachen, Germany
| | - Nardeen Kader
- Department of Orthopedics, South West London Elective Orthopaedic Centre (SWLEOC), Dorking Rd, Epsom KT18 7EG, UK
| | - Jörg Eschweiler
- Department of Orthopedic, Trauma, and Reconstructive Surgery, RWTH University Hospital of Aachen, 52074 Aachen, Germany
| | - Markus Tingart
- Department of Orthopedic, Trauma, and Reconstructive Surgery, RWTH University Hospital of Aachen, 52074 Aachen, Germany
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi (SA), Italy.,School of Pharmacy and Bioengineering, Keele University Faculty of Medicine, Thornburrow Drive, 01782 Stoke on Trent, UK.,Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, 275 Bancroft Road, London E1 4DG, UK
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Lynch JT, Spratford W, Perriman DM, Sizeland TJB, Gilbert S, Smith PN, Fearon AM. Individuals with gluteal tendon repair display similar hip biomechanics to those of a healthy cohort during a sit-to-stand task. Gait Posture 2021; 89:61-66. [PMID: 34243137 DOI: 10.1016/j.gaitpost.2021.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 05/31/2021] [Accepted: 06/28/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Gluteal-tendon repair (GTR) is reported to be effective for relieving pain and improving clinical function in patients with gluteal-tendon tears. The sit-to-stand (STS) task is an important activity of daily living and is often used to assess functional capacity in clinical populations. Understanding if and how STS performance is altered in individuals with gluteal tendon repair may be an effective marker of GTR outcomes as well as a possible therapeutic target for post-operative rehabilitation. RESEARCH QUESTION Do biomechanical parameters during STS differ between age- and sex-matched participants with and without gluteal-tendon repair? METHODS 27 participants with a GTR and 29 healthy participants performed the STS task. Data were acquired using the three-dimensional motion capture system and forceplates. Outcomes of interest were task duration, rate of force development, trunk, pelvis, and hip joint angles, moments and powers. Differences were assessed using Generalised linear multivariate models and statistical parametric mapping. RESULTS GTR patients performed the STS movement significantly slower (1.4+/- 0.40 s) compared to controls (1.1+/ -0.2 s) with a significantly lower rate of force development (35.1+/- 5.7 N/kg/ms vs 30.3+/- 8.5 N/kg/ms). There were no group differences for hip, pelvis, or trunk angle over the movement cycle or for maximal or minimal values. Furthermore, there were no significant differences detected in hip joint kinetics. However, there appeared to be substantial between-subject variability indicating different patient-specific movements patterns. SIGNIFICANCE Individuals with a GTR performed the STS task about 20 % slower than healthy controls with a lower rate of force development. The individual variations indicate that participants likely employed different movement strategies to achieve STS. While the lack of differences between groups could suggest that GTR helps restore function and corrects the proposed underlying aetiology, it is possible that the STS task was not sufficiently challenging to discriminate between groups.
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Affiliation(s)
- Joseph T Lynch
- Australian National University Medical School, Trauma and Orthopaedic Research Unit, The Canberra Hospital, Canberra, Australia.
| | - Wayne Spratford
- University of Canberra Health Research Institute, University of Canberra, Canberra, Australia.
| | - Diana M Perriman
- Australian National University Medical School, Trauma and Orthopaedic Research Unit, The Canberra Hospital, Canberra, Australia.
| | | | - Sally Gilbert
- Australian National University Medical School, Canberra, Australia.
| | - Paul N Smith
- Australian National University Medical School, Trauma and Orthopaedic Research Unit, The Canberra Hospital, Canberra, Australia.
| | - Angela M Fearon
- University of Canberra Health Research Institute, University of Canberra, Canberra, Australia.
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Plinsinga ML, Coombes BK, Mellor R, Vicenzino B. Individuals with Persistent Greater Trochanteric Pain Syndrome Exhibit Impaired Pain Modulation, as well as Poorer Physical and Psychological Health, Compared with Pain-Free Individuals: A Cross-Sectional Study. PAIN MEDICINE 2021; 21:2964-2974. [PMID: 32232468 DOI: 10.1093/pm/pnaa047] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To compare physical, sensory, and psychosocial factors between individuals with greater trochanteric pain syndrome and controls and to explore factors associated with pain and disability. DESIGN Cross-sectional study. SETTING General community. SUBJECTS Patients with persistent, clinically diagnosed greater trochanteric pain syndrome and healthy controls. METHODS Participants completed tests of thermal and pressure pain threshold, conditioned pain modulation, temporal summation, muscle strength, physical function, physical activity, psychological factors, and health-related quality of life. Standardized mean differences between groups were calculated, and multiple linear regression identified factors associated with pain and disability. RESULTS Forty patients (95% female, average [SD] age = 51 [9] years) and 58 controls (95% female, average [SD] age = 53 [11] years) were included. Heat pain threshold, temporal summation, and pain catastrophizing were not different between groups. Compared with controls, patients displayed significantly poorer quality of life (standardized mean difference = -2.66), lower pressure pain threshold locally (-1.47, remotely = -0.57), poorer health status (-1.22), impaired physical function (range = 0.64-1.20), less conditioned pain modulation (-1.01), weaker hip abductor/extensor strength (-1.01 and -0.59), higher depression (0.72) and anxiety (0.61) levels, lower cold pain threshold locally (-0.47, remotely = -0.39), and less time spent in (vigorous) physical activity (range = -0.43 to -0.39). Twenty-six percent of pain and disability was explained by depression, hip abductor strength, and time to complete stairs. CONCLUSIONS Patients with greater trochanteric pain syndrome exhibited poorer health-related quality of life, physical impairments, widespread hyperalgesia, and greater psychological distress than healthy controls. Physical and psychological factors were associated with pain and disability.
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Affiliation(s)
- Melanie Louise Plinsinga
- Department of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Brooke Kaye Coombes
- Department of Physiotherapy, School of Allied Health Sciences, Griffith University, Brisbane, QLD, Australia
| | - Rebecca Mellor
- Department of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Bill Vicenzino
- Department of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
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Toscano A, Costa GG, Rocchi M, Saracco A, Pignatti G. Giant hemorrhagic trochanteric bursitis mimicking a high-grade soft tissue sarcoma: report of two cases. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021043. [PMID: 33944848 PMCID: PMC8142766 DOI: 10.23750/abm.v92is1.9151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 02/09/2020] [Indexed: 11/23/2022]
Abstract
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.
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Affiliation(s)
- Angelo Toscano
- Rizzoli-Sicilia Department, IRCCS Istituto Ortopedico Rizzoli.
| | | | | | - Alvise Saracco
- Rizzoli-Sicilia Department, IRCCS Istituto Ortopedico Rizzoli.
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Tso CKN, O'Sullivan R, Khan H, Fitzpatrick J. Reliability of a Novel Scoring System for MRI Assessment of Severity in Gluteal Tendinopathy: The Melbourne Hip MRI Score. Orthop J Sports Med 2021; 9:2325967121998389. [PMID: 33997062 PMCID: PMC8072851 DOI: 10.1177/2325967121998389] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 11/24/2020] [Indexed: 11/17/2022] Open
Abstract
Background Gluteal tendinopathy is commonly reported in the literature, but there is a need for a validated magnetic resonance imaging (MRI)-based scoring system to grade the severity of the tendinopathy. Purpose To use intra- and interobserver reliability to validate a new scoring system, the Melbourne Hip MRI (MHIP) score, for assessing the severity of gluteal tendinopathy. Study Design Cohort study (diagnosis); Level of evidence, 3. Methods The MHIP score assesses gluteal tendinopathy according to each 1 of 5 categories: (1) extent of tendon pathology (maximum 5 points); (2) muscle atrophy (maximum 4 points); (3) trochanteric bursitis (maximum 4 points); (4) cortical irregularity (maximum 3 points); and (5) bone marrow edema (maximum 1 point), with an overall range of 0 to 17 (most severe). A total of 41 deidentified MRI scans from 40 patients diagnosed with gluteal tendinopathy (mean baseline age, 57.44 ± 25.26 years; 4 male, 36 female) were read and graded according to MHIP criteria by 2 experienced musculoskeletal radiologists. The radiologists were blinded to previous reports, and the scans were read twice within a 2-month period. Statistical analysis using the intraclass correlation coefficient (ICC) was used to determine intra- and interobserver reliability and mean/range for the MHIP scores. Results Of a total of 123 readings, the mean MHIP score (±SD) was 3.93 ± 2.24 (range, 0-17 points). The MHIP score demonstrated excellent reliability for determining the severity of gluteal tendinopathy on MRI. The ICC for intra- and interobserver reliability was 0.81 (95% CI, 0.67-0.89) and 0.78 (95% CI, 0.62-0.87), respectively. Conclusion The MHIP score had excellent intra- and interobserver reliability in scoring gluteal tendinopathy. This score allows gluteal tendon pathology to be graded prior to treatment and to be used for standardized comparisons between results in future research undertaking radiological review of gluteal tendinopathy.
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Affiliation(s)
- Chi Kin Nathan Tso
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Richard O'Sullivan
- Department of Medicine, Monash University, Melbourne, Australia.,Healthcare Imaging Services, Richmond, Melbourne, Australia
| | - Hussain Khan
- Australasian College of Sports and Exercise Physicians, Melbourne, Australia
| | - Jane Fitzpatrick
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia.,Epworth Healthcare, Richmond, Melbourne, Australia.,Joint Health Institute, Richmond, Melbourne, Australia
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Translation, cross-cultural adaptation and validation of the Brazilian Portuguese version of the Victorian Institute of Sports Assessment for Gluteal Tendinopathy patient reported-outcome measure (VISA-G.BR). Musculoskelet Sci Pract 2021; 52:102341. [PMID: 33581429 DOI: 10.1016/j.msksp.2021.102341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 01/28/2021] [Accepted: 02/02/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Different outcome measures can be used to assess pain and disability in individuals with Greater Trochanteric Pain Syndrome (GTPS), including the Victorian Institute of Sports Assessment for Gluteal Tendinopathy (VISA-G), Oswestry Disability Index (ODI), Patient Specific Functional Scale (PSFS) and Global Perceived Effect (GPE). OBJECTIVE To translate, cross-culturally adapt and validate VISA-G to Brazilian Portuguese and to evaluate the measurement properties of the VISA-G.BR, ODI, GPE, and PSFS in individuals with GTPS. DESIGN This is a longitudinal clinimetric study. METHODS Sixty-eight individuals with GTPS participated in this study. The questionnaires VISA-G.BR, ODI, PSFS, and GPE were administered to participants at the initial assessment, 24-48 h and 30 days after the initial assessment. Internal consistency and construct validity for the VISA-G.BR were assessed. Reliability, agreement, ceiling and floor effect, and responsiveness were described for all instruments. RESULTS The Cronbach Alpha for internal consistency value for VISA-G.BR was 0.65. The construct validity analysis showed a strong correlation value between ODI and VISA-G.BR (r = -0.77). The agreement analysis performed for all questionnaires showed standard error of measurement values ranging from 0.64 (PSFS) to 4.2 (VISA-G.BR). GPE scale had a floor effect. The responsiveness analysis performed for all questionnaires showed low values of effect size ranging from -0.07 to 0.3. CONCLUSION The VISA-G.BR is a valid and reliable instrument to assess the disability of individuals with GTPS. The ODI and PSFS instruments can also be used in the evaluation of this population.
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Jarlborg M, Courvoisier DS, Faundez A, Brulhart L, Finckh A, Nissen MJ, Genevay S. Greater trochanteric pain syndrome: predicting who will respond to a local glucocorticoid injection. Scand J Rheumatol 2021; 50:455-461. [PMID: 33685306 DOI: 10.1080/03009742.2021.1871643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objectives: This study aimed to explore whether certain clinical tests or a rapid improvement in lateral hip pain following periarticular injection are predictive of subsequent efficacy of local glucocorticoid (GC) injection in greater trochanteric pain syndrome (GTPS).Method: This secondary analysis of a randomized controlled trial of an injection of GC and local anaesthetic (LA) versus placebo included 44 patients with GTPS. Two subgroups of patients were defined: (i) 30 min responders, reporting a decrease of ≥ 50% of the initial pain at 30 min post-injection; and (ii) positive triple test, presenting a combination of three positive clinical tests (30-second single-leg stance, FABER, and Lequesne). Median level of numeric rating scale for pain at 1 month was the primary outcome. Interaction analysis of treatment effect in the subgroups was performed using a linear regression adjusting for pain at baseline.Results: Sixteen patients (36%) were 30 min responders. In this group, GC treatment was associated with a significant improvement in pain at 1 month compared to non-responders (p = 0.03). The 30 min response was not associated with the use of LA. Positive triple test (22% of patients) was associated with higher pain scores at baseline (p = 0.03). In this group, patients who received placebo had significantly more pain at 1 month than those with the cortisone injection (p = 0.04).Conclusion: Patients with GTPS who present a rapid decrease in pain after periarticular injection, and those who display a combination of three specific clinical tests, are more likely to benefit from an injection with GC and anaesthetic.
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Affiliation(s)
- M Jarlborg
- Department of Rheumatology, Geneva University Hospital, Geneva, Switzerland
| | - D S Courvoisier
- Department of Rheumatology, Geneva University Hospital, Geneva, Switzerland
| | - A Faundez
- Department of Orthopaedic Surgery, Geneva University Hospital, Geneva and Hospital La Tour Spine Center, Meyrin, Switzerland
| | - L Brulhart
- Department of Rheumatology, Geneva University Hospital, Geneva and Neuchâtel Hospital, La Chaux-de-Fonds, Switzerland
| | - A Finckh
- Department of Rheumatology, Geneva University Hospital, Geneva, Switzerland
| | - M J Nissen
- Department of Rheumatology, Geneva University Hospital, Geneva, Switzerland
| | - S Genevay
- Department of Rheumatology, Geneva University Hospital, Geneva, Switzerland
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Collier TS, Poole B, Bradford B. An indirect evaluation between corticosteroid injections and gluteal exercises in the management of pain in greater trochanteric pain syndrome. PHYSICAL THERAPY REVIEWS 2021. [DOI: 10.1080/10833196.2021.1879986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Thomas Samuel Collier
- Musculoskeletal Department, Pure Physiotherapy Specialist Clinics, Norwich, Norfolk, UK
- University of East Anglia, Norwich, Norfolk, UK
| | - Bradley Poole
- Musculoskeletal Department, North Cotswolds Hospital, Moreton-in-Marsh, UK
| | - Ben Bradford
- Musculoskeletal Department, Pure Physiotherapy Specialist Clinics, Norwich, Norfolk, UK
- University of East Anglia, Norwich, Norfolk, UK
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Meghpara MB, Yelton MJ, Annin S, Rosinsky PJ, Shapira J, Maldonado DR, Lall AC, Domb BG. Return to Activity After Gluteus Medius Repair in Active Patients Older Than 50 Years. Orthop J Sports Med 2021; 9:2325967120967968. [PMID: 33553438 PMCID: PMC7844460 DOI: 10.1177/2325967120967968] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 06/30/2020] [Indexed: 01/06/2023] Open
Abstract
Background: Gluteus medius (GM) tears are a known cause of dysfunction and disability predominantly in older women. Purpose To report on return to activity, patient-reported outcomes (PROs), and a uniquely calculated minimal clinically important difference (MCID) at a minimum 2-year follow-up for active patients who had undergone either an endoscopic or an open GM repair. Study Design: Case series; Level of evidence, 4. Methods: Patients were considered eligible if they (1) underwent a GM repair with or without concomitant central and peripheral compartment procedures; (2) had baseline preoperative and minimum 2-year scores for the modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), Hip Outcome Score–Sports Specific Subscale (HOS-SSS), and visual analog scale (VAS) for pain; and (3) participated in a physical activity or sport within 1 year before their surgery. Return to activity was defined as the patient being able to participate in his or her activity at a minimum of 2 years postoperatively. Results: Of 87 eligible patients, 84 (96.6%) met all inclusion criteria. The mean follow-up was at 44.5 months. Six patients (7.1%) underwent an open GM repair, while the remaining 78 (92.9%) underwent an endoscopic GM repair. Concomitant central and peripheral compartment arthroscopic procedures were performed in 69 patients (82.1%). All PROs significantly (P < .001) improved as follows: mHHS, from 59.0 to 85.8; NAHS, from 57.9 to 84.0; HOS-SSS, from 32.6 to 63.7; and VAS pain, from 5.4 to 1.9. A total of 57 patients (67.9%) returned to their preoperative activity at the 2-year follow-up. The MCID was calculated for the mHHS, NAHS, and HOS-SSS to be 7.5, 7.4, and 10.9, respectively, with 79.3%, 86.4%, and 70.2% of patients achieving the MCID for each respective PROs. Conclusion: Active patients over the age of 50 years may benefit from endoscopic or open repair of GM tears, as the majority of patients in our cohort were able to return to their activity of choice. All measured PROs had significantly improved at a minimum 2-year follow-up, with high survivorship, satisfaction, and clinical effectiveness. Patients with partial-thickness tears compared with full-thickness tears and those who underwent isolated GM repair compared with GM repair with concomitant procedures had similar return to activity rates and PROs at the latest follow-up.
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Affiliation(s)
- Mitchell B Meghpara
- American Hip Institute Research Foundation, Chicago, Illinois, USA.,AMITA Health St Alexius Medical Center, Hoffman Estates, Illinois, USA
| | | | - Shawn Annin
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | | | - Jacob Shapira
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | | | - Ajay C Lall
- American Hip Institute Research Foundation, Chicago, Illinois, USA.,AMITA Health St Alexius Medical Center, Hoffman Estates, Illinois, USA.,American Hip Institute, Chicago, Illinois, USA
| | - Benjamin G Domb
- American Hip Institute Research Foundation, Chicago, Illinois, USA.,AMITA Health St Alexius Medical Center, Hoffman Estates, Illinois, USA.,American Hip Institute, Chicago, Illinois, USA
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Millar NL, Silbernagel KG, Thorborg K, Kirwan PD, Galatz LM, Abrams GD, Murrell GAC, McInnes IB, Rodeo SA. Tendinopathy. Nat Rev Dis Primers 2021; 7:1. [PMID: 33414454 DOI: 10.1038/s41572-020-00234-1] [Citation(s) in RCA: 266] [Impact Index Per Article: 88.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/11/2020] [Indexed: 12/14/2022]
Abstract
Tendinopathy describes a complex multifaceted pathology of the tendon, characterized by pain, decline in function and reduced exercise tolerance. The most common overuse tendinopathies involve the rotator cuff tendon, medial and lateral elbow epicondyles, patellar tendon, gluteal tendons and the Achilles tendon. The prominent histological and molecular features of tendinopathy include disorganization of collagen fibres, an increase in the microvasculature and sensory nerve innervation, dysregulated extracellular matrix homeostasis, increased immune cells and inflammatory mediators, and enhanced cellular apoptosis. Although diagnosis is mostly achieved based on clinical symptoms, in some cases, additional pain-provoking tests and imaging might be necessary. Management consists of different exercise and loading programmes, therapeutic modalities and surgical interventions; however, their effectiveness remains ambiguous. Future research should focus on elucidating the key functional pathways implicated in clinical disease and on improved rehabilitation protocols.
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Affiliation(s)
- Neal L Millar
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK.
| | | | - Kristian Thorborg
- Institute of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
| | - Paul D Kirwan
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Leesa M Galatz
- Department of Orthopaedic Surgery, Icahn School of Medicine, Mount Sinai Health System, New York, NY, USA
| | - Geoffrey D Abrams
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Iain B McInnes
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
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Lateral Trochanteric Pain Following Primary Total Hip Arthroplasty: Incidence and Success of Nonoperative Treatment. J Arthroplasty 2021; 36:193-199. [PMID: 32778414 DOI: 10.1016/j.arth.2020.07.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/08/2020] [Accepted: 07/16/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Our study aimed at quantifying the overall incidence of lateral trochanteric pain (LTP) following total hip arthroplasty (THA) and risk based on surgical approach. The success of conservative treatment and potential risk factors for failure of conservative treatment were evaluated. METHODS This is a retrospective review of patients who underwent primary THA between 2010 and 2019 and had a postoperative diagnosis of ipsilateral LTP. Chart review revealed patient demographics/comorbidities, preoperative diagnosis, surgical approach, femoral components, and nonoperative treatment modalities. Radiographic analysis was performed to measure leg length discrepancy, femoral offset, and femoral head lateralization. RESULTS The incidence of LTP following primary THA was 1.70% (573/33,761) with an average time to diagnosis of 27.3 months. The direct anterior approach demonstrated the highest risk and the direct lateral demonstrated the lowest risk for LTP (P < .001). Also, 82.4% (472/573) were diagnosed greater than 6 months postoperatively (P < .001). Of 573 patients, 95 (16.6%) were treated with physical therapy, home exercises, or oral medications with a success rate of 96.8% (92/95). Remaining 478 (83.4%) were treated with corticosteroid injection (CSI). And 89.5% (428/478) of the CSI cohort demonstrated clinical improvement with 3 or less CSIs. Risk factors for failure of conservative treatment were depression (P = .034), kidney disease (P = .040), and osteoporosis (P = .007). CONCLUSION Postoperative LTP after THA is rare with an incidence of 1.70%. The direct anterior approach presented higher risk of LTP. Non-CSI modalities and CSIs were both successful treatment options. In patients with depression, kidney disease, and osteoporosis, conservative treatment may be less efficacious.
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ROSÁRIO DAVIARAÚJOVEIGA, FALEIRO THIAGOBATISTA, FRANCO BRUNOADELMOFERREIRAMENDES, DALTRO GILDÁSIODECERQUEIRA, MARCHETTO REINALDO. COMPARISON BETWEEN CONCENTRATED BONE MARROW ASPIRATE AND CORTICOID IN GLUTEAL TENDINOPATHY. ACTA ORTOPEDICA BRASILEIRA 2021; 29:26-29. [PMID: 33795965 PMCID: PMC7976861 DOI: 10.1590/1413-785220212901236828] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To compare bone marrow aspirate concentrate (BMAC) with the standard treatment for gluteal tendinopathies. METHODS 48 patients diagnosed with gluteal tendinopathy at a university hospital were selected by a randomized clinical trial and divided into two groups: (G1) bone marrow aspirate concentrate and (G2) corticosteroid injections. RESULTS 40 of the 48 selected patients were monitored for six months and both groups showed better scores. Visual analog scale (VAS) scores and Lequesne index were statistically significant higher in patients submitted to BMAC treatment when compared to standard treatment. Both groups improved their quality of life, without statistically significant difference. CONCLUSION BMAC constitutes an alternative to gluteal tendinopathy standard treatment, proving to be a safe technique with promising results when combined with multidisciplinary team behavioral therapy. Level of Evidence II, Randomized Clinical Trial.
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50
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Sizeland TJB, Fearon AM, Perriman DM, Gilbert S, Lynch JT, Smith PN, Spratford W. People after gluteal tendon repair have gait characteristics which are similar to those of a healthy cohort. Clin Biomech (Bristol, Avon) 2020; 80:105176. [PMID: 33007675 DOI: 10.1016/j.clinbiomech.2020.105176] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 08/13/2020] [Accepted: 09/09/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Gluteal-tendon repair is reported to be effective for relieving pain and improving function in patients with gluteal-tendon tears. However, post-operative three-dimensional gait analysis has never been conducted in gluteal-tendon repair patients. Thus, our primary aim was to investigate how biomechanical gait parameters differ between age- and sex-matched participants with and without gluteal-tendon repair. METHODS Vicon motion analysis technology was used to measure gait characteristics of 25 gluteal-tendon repair participants and 29 matched healthy comparison group participants. A generalised linear multivariate model was used to compare external hip-adduction moment, range of movement in hip adduction and internal rotation, pelvic obliquity, trunk lean, stride length and velocity of both cohorts throughout stance. FINDINGS There were no differences between the groups in external hip adduction moment, pelvic obliquity and range of movement in hip adduction and internal rotation. Gluteal-tendon repair participants had a shorter stride length (P = 0.031) and reduced walking velocity (P = 0.015). Ipsilateral trunk lean was reduced in gluteal-tendon repair participants at the first-peak external hip-adduction moment (P = 0.016), mid-stance minimum external hip-adduction moment (P = 0.029) and second-peak external hip-adduction moment (P = 0.006). INTERPRETATION There were no differences between the gluteal-tendon repair and comparison groups for external hip-adduction moment and pelvic obliquity. This suggests that gluteal-tendon repair may restore hip control in stance. Slower walking speed, reduced stride length and decreased ipsilateral trunk lean may reflect persistence of pre-operatively developed gait adaptations. Future studies of gait biomechanics before and after gluteal-tendon repair would be needed to substantiate this theory.
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Affiliation(s)
| | - Angela M Fearon
- University of Canberra Health Research Institute, University of Canberra, Canberra, Australia.
| | - Diana M Perriman
- Australian National University Medical School, Trauma and Orthopaedic Research Unit, the Canberra Hospital, Canberra, Australia.
| | - Sally Gilbert
- Australian National University Medical School, Canberra, Australia.
| | - Joseph T Lynch
- Australian National University Medical School, Trauma and Orthopaedic Research Unit, the Canberra Hospital, Canberra, Australia.
| | - Paul N Smith
- Australian National University Medical School, Trauma and Orthopaedic Research Unit, the Canberra Hospital, Canberra, Australia.
| | - Wayne Spratford
- University of Canberra Health Research Institute, University of Canberra, Canberra, Australia.
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