Assessing Trochanteric Pain after Total Hip Arthroplasty
Although greater trochanteric pain syndrome – often referred to as trochanteric bursitis – has no validated definition, orthopaedic surgeons know what it is: The pain and tenderness that develops over a patient’s lateral hip after total hip arthroplasty (THA) and that may be associated with a pseudoradiculopathy of shooting pain down the leg.
At the 7th Annual ICJR South Hip & Knee Course, Thomas L. Bradbury, MD, from Emory Orthopaedics & Spine Center in Atlanta, Georgia, told attendees that in most cases, an abductor tear is the cause of trochanteric pain following THA, [1,2] but the diagnosis is one of exclusion: Surgeons need to rule out referred pain from lumbar spine pathology, [3,4] trunnionosis, and infection.
So, when patients present with trochanteric symptoms, surgeons should do their “due diligence” to determine the cause, Dr. Bradbury said, including:
- Physical exam, comparing pre-THA and post-THA findings
- Labs, including inflammatory seromarkers and serum metal ion levels
- Imaging, including radiographs and a MARS MRI
Dr. Bradbury said the hip lag sign is a good indicator of abductor tears, correlating well with MRI findings, as is pain with palpation combined with pain with a single leg stance. 
Click the image above to watch Dr. Bradbury’s presentation and get more details about causes of greater trochanteric pain syndrome following THA.
Disclosures: Dr. Bradbury has no disclosures relevant to this presentation.
- Cates HE, Schmidt MA, Person RM. Incidental “rotator cuff tear of the hip” at primary total hip arthroplasty. Am J Orthop. 2010 Mar;39(3):131-3.
- Hendry J, Biant LC, Breusch SJ. Abductor mechanism tears in primary total hip arthroplasty. Arch Orthop Trauma Surg. 2012 Nov;132(11):1619-23. doi: 10.1007/s00402-012-1573-9. Epub 2012 Jul 5.
- Tan LA, Benkli B, Tuchman A, et al. High prevalence of greater trochanteric pain syndrome among patients presenting to spine clinic for evaluation of degenerative lumbar pathologies. J Clin Neurosci. 2018 Jul;53:89-91. doi: 10.1016/j.jocn.2018.04.030. Epub 2018 Apr 20.
- Kido T, Okuyama K, Chiba M. Clinical diagnosis of upper lumbar disc herniation: pain and/or numbness distribution are more useful for appropriate level diagnosis. J Orthop Sci. 2016 Jul;21(4):419-424. doi: 10.1016/j.jos.2016.03.003. Epub 2016 Apr 2.
- Grimaldi A, Mellor R, Nicolson P, Hodges P, Bennell K, Vincenzino B. Utility of clinical tests to diagnose MRI-confirmed gluteal tendinopathy in patients presenting with lateral hip pain. Br J Sports Med. 2017 Mar;51(6):519-524. doi: 10.1136/bjsports-2016-096175. Epub 2016 Sep 15.