Endoscopic treatment of the Retro-trochanteric Pain Syndrome. A quality study with medium-term follow-up

Abstract

Introduction. Retro-trochanteric pain syndrome (RTPS) is a condition characterized by pain and tenderness in the buttock region. Normally sciatica originates from pathology in the spine. In RTPS the pathology resulting in sciatica is localized in the buttock region. First line treatment for RTPS is physiotherapy. This study evaluate treatment of RTPS by endoscopic bursectomy and microtenotomy of the short rotator affecting the sciatic nerve. Patients and methods. 11 patients (12 hips) operated with endoscopic bursectomy and microtenotomy of a short rotator for treatment of RTPS were included in the study. The average age of the patients (1 male and 10 female) were 57.2 years and the mean duration of symptoms were 6.7 years. All patients had failed preoperative attempts of conservative treatment such as physiotherapy, NSAIDs and local steroid injections. The short-term follow-up was 3 months and the mean medium-term follow-up was 5 years. We evaluated the level of pain (using the visual analogue scale, VAS), function and clinical examination preoperatively, at 3 months and at 5 years. We also evaluated level of satisfaction and postoperative time without symptoms. Standard radiographs of the pelvis and hips and MRI of the lumbar spine, pelvis and hips were done preoperative and at medium-term follow-up. Results. Pain significantly decreased from a mean VAS of 8.3 (SD 0.99) to 2.4 (SD 1.7), p-value = 0.002 at short-term and 5.1 (SD 2.6), p-value = 0.006 at medium-term follow-up. The ability to sit and usage of pain medication had a significant improvement. Overall satisfaction was high. Between surgery and final follow-up five patients developed OA in the hip(s). Conclusion. Endoscopic bursectomy and microtenotomy of the small rotators in the hip are a valuable treatment method for patients with RTPS, the patients had significantly reduced pain and improved function five years after operation.