Evaluation of radiologic predisposing factors for greater trochanteric pain syndrome

Abstract

Objectives: Greater trochanteric pain syndrome (GTPS) is one of the causes of lateral hip pain. We aimed to determine the significance of certain anatomical parameters related to GTPS in imaging tests.

Methods: Data of patients who were treated with glucocorticoid injection for trochanteric bursitis in our clinic between July 2019 and July 2022 for GTPS were analyzed. The control group was constituted of patients without GTPS but with hip and spinal problems who had pelvic computerized tomography (CT) images and undergone robotic-assisted knee arthroplasty. Standard anteroposterior pelvic radiograms, pelvic CTs, or magnetic resonance images were evaluated for anatomical parameters.

Results: Among anatomical parameters, acetabular anteversion, length of trochanter major, and abductor index were significantly different between the patients with and without GTPS. Although mean age was different between the GTPS and control patient groups, age was not found to be correlated with any anatomical parameter. Abductor lever arm length (p = 0.001) and abductor index (p = 0.009) were found to be correlated.

Conclusions: The length of trochanter major and abductor index were shown to be predisposing anatomical parameters for GTPS.

Keywords

• Greater trochanteric pain syndrome
• hip pain
• acetabular anteversion
• abductor index

References

1. 1. Fearon A, Stephens S, Cook J, Smith P, Neeman T, Cormick W, et al. The relationship of femoral neck shaft angle and adiposity to greater trochanteric pain syndrome in women. a case control morphology and anthropometric study. Br J Sports Med 2012;46:888-92.
2. 2. Reid D. The management of greater trochanteric pain syndrome: a systematic literature review. J Orthop 2016;13:15-28.
3. 3. Lievense A, Bierma-Zeinstra S, Schouten B, Bohnen A, Verhaar J, Koes B. Prognosis of trochanteric pain in primary care. Br J Gen Pract 2005;55:199-204.
4. 4. Long SS, Surrey DE, Nazarian LN. Sonography of greater trochanteric pain syndrome and the rarity of primary bursitis. AJR Am J Roentgenol 2013;201:1083-6.
5. 5. Ege Rasmussen KJ, Fanø N. Trochanteric bursitis. Treatment by corticosteroid injection. Scand J Rheumatol 1985;14:417-20.
6. 6. Williams BS, Cohen SP. Greater trochanteric pain syndrome: a review of anatomy, diagnosis and treatment. Anesth Analg 2009;108:1662-70.
7. 7. Tortolani PJ, Carbone JJ, Quartararo LG. Greater trochanteric pain syndrome in patients referred to orthopedic spine specialists. Spine J 2002;2:251-4.
8. 8. Dunn T, Heller CA, McCarthy SW, Dos Remedios C (2003) Anatomical study of the “trochanteric bursa”. Clin Anat 2003;16:233-40.

9. 9. Grimaldi A, Fearon A. Gluteal tendinopathy: integrating pathomechanics and clinical features in its management. J Orthop Sports Phys Ther 2015;45:910-22.
10. 10. Govaert LH, van der Vis HM, Marti RK, Albers GH. Trochanteric reduction osteotomy as a treatment for refractory trochanteric bursitis. J Bone Joint Surg Br 2003;85:199-203.
11. 11. Pelsser V, Cardinal E, Hobden R, Aubin B, Lafortune M. Extraarticular snapping hip: sonographic findings. AJR Am J Roentgenol 2001;176:67-73.
12. 12. Santos LEN, Navarro TP, Machado CJ, de Amorim Cabrita HAB, Pires RE, Figuriredo LB, et al. Relationship of the Pelvic-Trochanteric Index with greater trochanteric pain syndrome. Clinics (Sao Paulo). 2021;76:e3312. Published 2021 Nov 26. doi:10.6061/clinics/2021/e3312
13. 13. Canetti R, de Saint Vincent B, Vieira TD, Fière V, Thaunat M. Spinopelvic parameters in greater trochanteric pain syndrome: a retrospective case-control study. Skeletal Radiol 2020;49:773-8.