Sports Medicine Research: In the Lab & In the Field: Efficacy of Treatment of Trochanteric Bursitis: A Systematic Review (Sports Med Res)


Monday, September 26, 2011

Efficacy of Treatment of Trochanteric Bursitis: A Systematic Review

Efficacy of Treatment of Trochanteric Bursitis: A Systematic Review

Lustenberger DP, Ng VY, Thomas M. Best TM, Ellis TJ. Clin J Sport Med. 2011 Sept; Vol 21(5), 447-453.

Trochanteric bursitis presents as lateral hip pain and can be a very frustrating condition to treat. To date, there have been no systematic reviews of the literature comparing the various treatment modalities used. In this systematic review, the authors attempt to evaluate the efficacy of the various treatments for trochanteric bursitis. They conducted a literature search to identify articles on trochanteric bursitis treatment and compared the efficacy of the various treatment options. Twenty-four articles were included in the review resulting in more than 950 cases of trochanteric bursitis. Nine studies looked at steroid injections as the lone treatment. Two studies evaluated an interdisciplinary conservative approach involving rest, physical therapy, therapeutic ultrasound, corticosteroid injections, as well as ice and heat in various combinations. Low-energy shock-wave therapy was evaluated in 2 studies and 13 studies examined surgical procedures for trochanteric bursitis. Outcomes were compared based on improvements in the visual-analog pain scale (VAS) and the Harris Hip Scores (HHS) reported in the studies. The authors found that the efficacy of the various surgical techniques depended on the clinical outcome measure, but all surgical interventions were superior to non-operative management based on the VAS and HHS. The review also demonstrated that non-operative treatment helped most patients (range of symptom resolution from 49% to 100%) and that shock-wave therapy was found to be better than other non-operative therapies in the 2 studies evaluating its efficacy.

Trochanteric bursitis is a difficult topic to perform a literature review because this diagnosis implies a very specific problem (i.e., inflammation of the trochanteric bursa), but in clinical practice, the term is used more broadly to encompass lateral hip pain of multiple causes. This has led some clinicians to apply the term “Greater Trochanter Pain Syndrome” to this diagnosis rather than “bursitis”.  The authors note that it is challenging to compare studies on trochanteric bursitis treatment given the lack of universal diagnostic criteria and the results of this review should be interpreted with that in mind. Although 9 studies looked at injection treatment, there is no mention of what structures were injected. Both injection of the bursa itself as well as injection of the surrounding stabilizing musculature and tendons of the hip are used in clinical practice, and the efficacy of these injections may differ. Although the 2 studies on shock-wave therapy appear superior to other conservative treatments with better overall VAS and HHS improvements, only one of the studies demonstrated improvement that was statistically significant and the other study had a low level of evidence. The data suggesting that operative treatments are superior to a more conservative approach should also be interpreted with caution. The surgical techniques reported in the studies are all very different and include procedures to address the bursa itself (bursectomy) as well as the surrounding soft tissue (muscle/tendon debridement ± repair).  A possible explanation for the superiority of operative management versus non-operative treatment may arise from the fact that surgeons are only operating on patients with radiographically diagnosed bursitis while non-operative measures may be offered to patients with less specific lateral hip pain. What we can learn from this article is that nonsurgical interventions work for some patients and surgical interventions work for some patients with lateral hip pain. What we need to do now is further delineate what’s causing the hip pain. “Trochanteric bursitis” is a deceivingly simple term for a complex problem and its unclear which interventions might be best for particular case presentations.

Written by: Hallie Labrador, Marc Harwood
Reviewed by: Jeffrey Driban

Lustenberger DP, Ng VY, Best TM, & Ellis TJ (2011). Efficacy of treatment of trochanteric bursitis: a systematic review. Clinical journal of sport medicine, 21 (5), 447-53 PMID: 21814140


Mark Sutherlin said...

I enjoyed reading this article, as I agree with the statement that we probable are treating more lateral hip pain that true trochanteric bursitis. Being the first systematic review in this area, hopefully research can address some of the current limitations with treatment and injury management in this area. I find the current results interesting in that there were only two randomized controlled trials in the non operative treatments, with the majority being case series. Also when looking at the results of operative studies many of these studies have very low treatment numbers. I would be curious if the surgical studies were able to identify a true bursitis prior to operative management and how clinicians arrived at their assessment in the nonoperative studies. Additionally, I believe that future studies should focus on more patient oriented outcomes, looking across both short and long term durations to see if changes occur over time. Overall, interesting article and would be curious to see where future research continues following this systematic review.

Hallie Labrador said...

Agreed - there are many possible directions for research in this area. This article highlights some holes in the current literature on lateral hip pain/ trochanteric bursitis as you point out. Functional outcomes seems to be the hot area in research these days, so hopefully, we'll see more on this topic soon.

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