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
ARTICLE HIGHLIGHTS
Research background

Trochanteric bursitis is a common complication following total hip replacement (THR). It has a reported incidence of 4%-8% and is associated with high level of disability and poor quality of life.

Research motivation

For a decade, our lead author has performed prophylactic trochanteric bursectomy as part of the surgical approach for THR. The rationale being that the bursa is likely to fibrose following THR, losing its functional properties as friction buffer but still have the potential of developing bursitis at a later date. The procedure, therefore, seems logical as it could reduce the occurrence of post-operative trochanteric bursitis.

Research objectives

The study was conducted to evaluate whether synchronous trochanteric bursectomy at the time of THR affects the incidence of post-operative trochanteric bursitis.

Research 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.

Research 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.

Research conclusions

Synchronous trochanteric bursectomy at the time of THR does not materially affect the incidence of post-operative bursitis and may therefore be considered unnecessary. However, our series did show that it is successful at treating patients with known trochanteric bursitis and osteoarthritis requiring THR.

Research perspectives

Future research in the form of a clinical trial randomising patients to prophylactic trochanteric bursectomy vs non-bursectomy at the time of THR would be needed.