Retrospective Cohort Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Jul 18, 2023; 14(7): 533-539
Published online Jul 18, 2023. doi: 10.5312/wjo.v14.i7.533
Excision of trochanteric bursa during total hip replacement: Does it reduce the incidence of post-operative trochanteric bursitis?
Wai-Huang Teng, Adeel Ditta, Jane Webber, Oliver Pearce
Wai-Huang Teng, Adeel Ditta, Jane Webber, Oliver Pearce, Division of Trauma and Orthopaedics, Milton Keynes University Hospital, Milton Keynes MK6 5LD, United Kingdom
Author contributions: All authors have substantial contributions to this study; Teng WH, Webber J and Pearce O conceptualised and designed the research; Teng WH and Ditta A collected, analysed, and interpreted the data; Teng WH, Ditta A, Webber J and Pearce O contributed to writing of the manuscript.
Institutional review board statement: The study was registered with our institution’s Research and Development Department. Following review, it was confirmed that NHS Research Ethics Committee approval is not required.
Informed consent statement: Informed written consent was not obtained from individual patients as the study was purely observational, and only included anonymised and non-sensitive data.
Conflict-of-interest statement: All authors declare no conflict of interest related to the manuscript.
Data sharing statement: The original anonymous dataset is available on request from the corresponding author at waihuang0506@outlook.com.
STROBE statement: The authors have read the STROBE Statement, and the manuscript was prepared in accordance to the STROBE Statement – checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wai-Huang Teng, MBChB, Doctor, Surgeon, Division of Trauma and Orthopaedics, Milton Keynes University Hospital, Standing Way, Milton Keynes MK6 5LD, United Kingdom. waihuang0506@outlook.com
Received: March 24, 2023
Peer-review started: March 24, 2023
First decision: May 9, 2023
Revised: May 20, 2023
Accepted: May 25, 2023
Article in press: May 25, 2023
Published online: July 18, 2023
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.

Keywords: Total hip replacement, Trochanteric bursectomy, Trochanteric bursitis, Greater trochanteric pain syndrome

Core Tip: We investigated a plausible theory of prophylactic trochanteric bursectomy at the time of total hip replacement (THR) to reduce the incidence of post-operative bursitis. Our retrospective study included 954 patients over an 11-year period operated by two contemporary surgeons, one excising the bursa and the other not. From our analysis, we found no significant difference in the incidence of post-THR bursitis between the two groups. However, our series did demonstrate that synchronous trochanteric bursectomy during THR is successful at treating the lateral buttock pain component for patients with known trochanteric bursitis and osteoarthritis requiring THR; and therefore, we recommend the procedure in these patients.