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    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.

    RELATED: Register for the 8th Annual ICJR South Hip & Knee Course

    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. [5]

    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.

    References

    1. 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.
    2. 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.
    3. 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.
    4. 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.
    5. 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.