Assessing morbidity in patients with greater trochanteric pain syndrome (GTPS)

Introduction: Greater trochanteric pain syndrome (GTPS) continues to be a challenge among orthopedics to rid discomfort for their patients, especially since there are few studies on characterization of GTPS morbidity. Objective: The purpose of this study is to characterize the morbidity of GTPS in order to aid orthopedics in providing an early diagnosis and better treatment/care options for their patients. Methods: A total of 156 patients were included from January of 2016 to July of 2020. Refer to Figure 1 for a visual of inclusion criteria. All patient information was taken from first appointment notes, operative notes, chart reviews, and REDCap, an institutional database. Patient demographics and history of present illness were recorded. Patient’s hips were evaluated for activity, pain, general health using the UCLA Activity Score, modified Harris Hip Score (HHS), Hip Outcome Score (HOS), Hip disability and Osteoarthritis Outcome Score (HOOS), SF-12 and iHOT12. Patients were then matched with osteoarthritis patients, who were characterized by Tonnis grade of 2 or 3. Results: Patient report outcomes were analyzed. UCLA Activity Score average of 4.89, HOS average is 55.16, HOOS quality of life average is 31.91. SF-12 averages ranged as low as 41.31 for general health to as high as 81.14 for emotional role. iHOT12 score averaged 42.73. Discussion: Knowledge of the anatomy, patient profiles, differential diagnoses, and imaging can aid in appropriate diagnosis of lateral hip pain (2). This study was useful in characterizing GTPS in order to aid in diagnosis and treatment. Based on the findings, patient reports on varying hip scores and surveys are just as important as physical exams and imaging. Characterizing GTPS based on patients level of pain, activity, mental wellness all has an effect on better outcomes (1). There were a few limitations to this study. The majority of our patient population is older and female, in which their baseline function could be decreased (3). Missing values were another limitation. Lastly, this study is a retrospective case series without a control group, which makes it susceptible to various biases, such as selection bias. However, selection bias was diminished through our inclusion criteria. Clinical Relevance: Future studies can focus on incorporating patient reports and creating personalized treatment based off of those reports. In addition, future studies could also stage or phase GTPS based on symptoms, imaging, and patient reports in order to better characterize progression of the disease

The Morbidity of Greater Trochanteric Pain Syndrome is Similar to that of Hip Osteoarthritis Awaiting Total Hip Arthroplasty

Background: Greater trochanteric pain syndrome (GTPS) is characterized by chronic lateral hip pain and dysfunction. While psychosocial measures of other tendinopathies have been gaining traction, GTPS is less well studied. We sought to characterize the morbidity upon presentation of GTPS and compared it to patients with end-stage, hip osteoarthritis (OA) awaiting total hip arthroplasty (THA). Methods: This study examined patient reported outcomes measures (PROMs) on activity limitations, quality of life (QOL), pain, and level of disability, in all patients with GTPS and end-stage, pre-THA hip OA. All patients presented at a single academic medical center between October 2016 to November 2020. The PROMs were analyzed using an equivalence test and two-one-sided t-tests. Results: A total of 156 patients (193 hips) with GTPS and 300 patients (326 hips) with hip OA were investigated. Equivalence in mean UCLA Activity score between GTPS and OA groups were established with tolerance margin of ± 5. The difference in mean UCLA score was 0.002 (95% CI -0.45 to 0.43, p \u3c 0.01) between GTPS and OA patients. Equivalence in mean VAS score between GTPS and OA were established with tolerance margin of ± 10. The difference in mean VAS score was 0.35 (95% CI -0.86 to 0.16, p = 0.02). HOOSQol score was much worse in GTPS patients, placed well outside of the ± 10 tolerance margin and difference in means score was 1.72 (95% Cl -2.17 to -1.26, p = 0.99). All estimated differences were comparable with and without the adjustment for each PROM respectively, suggesting the differences (or the lack of) in the PROMs between GTPS and OA couldn’t be explained by the differences in sex, age, BMI, race, ethnicity, or smoking status. Conclusion: This cumulative evidence characterizes GTPS as painful and limiting in activities of daily living, as pre-THA hip OA, and with poorer quality of life scores than hip OA. This study validates results of other studies that have investigated PROMs between GTPS and pre-THA, hip OA patients. Clinicians and researchers should not underestimate the disease, and further research on characterizing the progression of the disease should be a priority

Changes in Severity of Pelvic Floor Dysfunction after Hip Surgery

Introduction: Despite growing evidence that suggests an association between hip pathology and pelvic floor disorder (PFD), the comprehensive effects of hip surgery on PFD symptoms are not well understood. The primary purpose of this study was to report the role of surgical hip procedures on the severity of PFD symptoms. Methods: A prospective database of demographic and outcome data for all female patients that were operated on between 2019-2020 at a single institution was queried. The PDFI-20 was used to assess symptom severity, and cases with both pre and postoperative surveys were included (n=62). MCID was used to determine significance of change in PDFI-20 score. Results: All patients were female and mean age was 50.1 years. 40 patients had a THA, 10 had a PAO, 9 had a hip arthroscopy, 2 had a surgical hip dislocation, and one had abductor repair and reconstruction. The pre- and postoperative PFDI-20 scores for patients who underwent THA were 40.4±40.1 and 31.5±35.8. The pre- and post-operative PFDI-20 scores for patients who underwent PAO were 10.6±16.9 and 5.3±12.4. The pre- and post-operative PFDI-20 scores for patients who underwent hip arthroscopy were 7.2±12 and 15.2±25.9. The pre- and post-operative PFDI-20 scores for patients who underwent surgical hip dislocation were 41.7±58.9 and 39.1±55.2. The pre- and post-operative PFDI-20 scores for patients who underwent abductor repair and reconstruction were 33.3±0 and 113.5±0. Conclusion: A subset of patients undergoing hip surgery do have baseline pelvic floor dysfunction. We did not find a significant improvement from pre and post op in our patient population. Mean PFDI-20 scores improved in patients who underwent THA, PAO, and surgical hip dislocation. This study demonstrates that the impact of hip surgery on PFD symptoms in patients with hip pathology should be considered, with further research required to fully characterize this relationship

The Morbidity of Greater Trochanteric Pain Syndrome is Similar to that of Pre-THA Hip Osteoarthritis

Aims: We sought to characterize the morbidity upon presentation of GTPS and compared it to patients with end-stage, hip osteoarthritis (OA) awaiting total hip arthroplasty (THA). We hypothesize that patients with GTPS will have similar or worse morbidity than hip OA patients. Methods: This retrospective case-control study examined patient reported outcomes measures (PROMs) on activity limitations, quality of life, pain, and level of disability, in 156 GTPS patients (193 hips) and 300 pre-THA hip OA patients (326 hips). All patients presented at a single academic medical center. Patients with secondary hip conditions or previous hip surgeries were excluded from the study. PROMs were analyzed using an equivalence test and two-one-sided t-tests. Results: Equivalence in mean UCLA Activity score between GTPS and OA groups were established with tolerance margin of ± 5. The difference in mean UCLA Activity score was 0.002 (95% CI -0.45 to 0.43, p \u3c 0.01) between GTPS and OA patients. Equivalence in mean VAS score between GTPS and OA were established with tolerance margin of ± 10. The difference in mean VAS score was 0.35 (95% CI -0.86 to 0.16, p = 0.02). HOOSQol score was much worse in GTPS patients, placed well outside of the ± 10 tolerance margin and difference in means score was 1.72 (95% Cl -2.17 to -1.26, p = 0.99). Conclusion: This cumulative evidence characterizes GTPS as painful and limiting in activities of daily living, as pre-THA hip OA, and with poorer quality of life scores than hip OA. Clinicians and researchers should consider GTPS as seriously as hip OA

The Morbidity of Greater Trochanteric Pain Syndrome Versus That of Patients Awaiting Total Hip Replacement

BACKGROUND: Greater trochanteric pain syndrome (GTPS) is a commonly diagnosed medical issue, yet there are little data assessing the relative morbidity of GTPS. We sought to characterize the morbidity on presentation of GTPS and compare it to that of patients with end-stage hip osteoarthritis awaiting total hip arthroplasty. We hypothesized that patients with GTPS would have morbidity similar to or worse than that of patients with osteoarthritis. MATERIALS AND METHODS: This retrospective case-control study examined patient-reported outcome measures of 156 patients with GTPS (193 hips) and 300 patients with hip osteoarthritis before total hip arthroplasty (326 hips). Patients with secondary hip conditions or previous hip surgeries were excluded from the study. Patient-reported outcome measures were analyzed using an equivalence test and two one-sided t tests. RESULTS: Equivalence in mean visual analog scale pain scores between GTPS and osteoarthritis was established with a tolerance margin of ±10. The difference in mean visual analog scale pain scores was 0.35 (95% CI, −0.86 to 0.16; P=.02). The Hip disability and Osteoarthritis Outcome Score Quality of Life was much worse for patients with GTPS, placed well outside of the ±10 tolerance margin, and the difference in mean scores was 1.72 (95% Cl, −2.17 to −1.26; P=.99). Equivalence in mean UCLA Activity scores between GTPS and osteoarthritis was established with a tolerance margin of ±5. The difference in mean UCLA Activity scores was 0.002 (95% CI, −0.45 to 0.43; P\u3c.01). CONCLUSION: The morbidity and functional limitations of patients with GTPS were similar to those of patients undergoing total hip arthroplasty. GTPS remains a functional problem for patients, and clinicians and researchers should consider GTPS as seriously as hip osteoarthritis