ObjectivesMinimally invasive surgical procedure for removal of the trochanteric bursa and, if necessary, exostosectomy and/or fixation
of the iliotibial tract at the greater trochanter.
IndicationsChronic, unsuccessfully treated trochanteric bursitis. Bursitis caused by snapping hip or due to exostosis at the greater
ContraindicationsInfected bursitis or bursitis in rheumatoid patients.
Surgical TechniqueThrough 2 approaches, cranial and caudal and slightly posterior to the tip of the trochanter, infiltration of the epitrochanteric
area with saline (Purisole®); the iliotibial tract is divided under endoscopic control. Subtotal removal of the trochanteric bursa using a synovial resector.
If necessary, the procedure can be extended to include a fixation of the tract with resorbable suture anchors.
ResultsSince June 1995, we performed an endoscopic bursectomy in 34 patients (28 women and 6 men, average age 57.8 years). The first
20 patients (18 women and 2 men, average age 52.6 years) had an average follow-up of 20 (12 to 36) months. Fifteen patients
were satisfied with the result. The degree of pain and functional handicap was assessed using a visual analog scale (10 points
for intense pain). This pain score amounted to 8.9 points before surgery, to 5.2 postoperatively, and to 4.3 at follow-up.
One instance of secondary healing was seen in a stab incision.
"The test was considered positive if the patient remained pain free between 1 and 4 h. We used a standardised approach   (Fig. 1) and the technique was previously described by Haaker et al. 2000 . In four cases with coxa saltans, the iliotibial tract was sutured to the greater trochanter using absorbable anchors. "
[Show abstract][Hide abstract] ABSTRACT: Between 1995 and 2000, we performed 45 endoscopic bursectomies in 42 patients (average age 51, range 17-61 years). All patients had at least 6 months of failed conservative treatment, and all responded positively to a sonographic-guided injection with Mepivacaine 0.5%. The bursa was removed using a synovial resector. An additional tractopexie was performed in four cases. We followed 37 patients for 12-48 months. Pre-operatively, the mean modified Japanese Orthopaedic Association (JOA) disability hip score was 40.5 points. It improved to 72.6 points after a mean of 25 months. Severe complications did not occur. The minimally invasive technique requires only stab incisions, and immobilisation and hospitalisation are minimal.
International Orthopaedics 09/2004; 28(4):218-21. DOI:10.1007/s00264-004-0569-7 · 2.11 Impact Factor
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