Greater Trochanteric Pain Syndrome
Greater Trochanteric Pain Syndrome (GTPS) is a term used to describe lateral hip pain caused by a combination of Trochanteric Bursitis and Gluteal Tendinopathy of the gluteus medius and/or gluteus minimis tendons. These tendons can also sustain tears just like the Rotator Cuff muscles in the shoulder.
It is most commonly found in females between 40 and 60 years of age and the proportion that each of the above conditions contribute to symptoms varies greatly. Gluteal tendon tears are often found in women over 60 years of age and can be totally asymptomatic. It is vital therefore that I performed a focused assessment and examination in order to identify what are the ‘pain generators’ specific for each patient as this may vary considerably. I often use one or two targeted injections to do this over several weeks but this is important in order to direct treatment accordingly and avoid unnecessary surgery.
What Treatments are Available?
The mainstay of non-surgical treatment is effective and sustained physiotherapy to improve the strength and function of the muscles around the hip. Simply analgesia and corticosteroid injections can be used to augment physiotherapy. Other injectable therapies include Platelet Rich Plasma (PRP) which is injected in order to try and get the inflamed tendons to heal. Non-surgical treatment is effective for the majority of patients but recovery is often slow so persistence is required.
Surgical treatments are only considered after I am certain patients have been compliant with other treatments and remain symptomatic. Decompression and/or removal of the trochanteric bursa together with any underlying bone spurs causing irritation can be performed using both open and arthroscopic (key-hole) techniques. When necessary torn muscle tendons can also be reconstructed.
I will discuss treatment options with you in detail with surgery only being recommended if non-operative methods fail.
Infection can occur with any operation. In the hip this can be superficial or deep. Infection rates are approximately 1%. If it occurs, it can be treated with antibiotics but may require further surgery. Very rarely your hip may need to be removed to eradicate infection.
These can form in the calf muscles and can travel to the lung (Pulmonary embolism). These can occasionally be serious and even life threatening. If you get calf pain or shortness of breath at any stage, you should notify your surgeon.
Ideally, your knee should bend beyond 115 degrees but on occasion, may not bend as well as expected. Sometimes manipulations are required. This means going to the operating room where the knee is bent for you while under anesthetic.
The plastic liner eventually wears out over time, usually over 10 to 15 years, and may need to be changed. Alternatively the remainder of your own knee may wear out requiring revision to a Total Knee Replacement.
Fractures or breaks can occur during surgery or afterwards if you fall. To repair these, you may require surgery.
The operation will always cut some skin nerves, so you will inevitably have some numbness around the wound. This does not affect the function of your joint. You can also get some aching around the scar. Vitamin E cream and massaging can help reduce this. Occasionally, you can get reactions to the sutures or a wound breakdown that may require antibiotics or rarely, further surgery.
The knee may look different than it was because it is put into the correct alignment to allow proper function.
Your leg will be restored to it’s original length as the deformity caused by wearing of the knee has been corrected.
There are a number of ligaments surrounding the knee. These ligaments can be torn during surgery or break or stretch out any time afterwards. Surgery may be required to correct this problem. This problem is minimised with Robotic Assistance.
Rarely these can be damaged at the time of surgery. If recognized they are repaired but a second operation may be required. Nerve damage can cause a loss of feeling or movement below the knee and can be permanent.
Discuss your concerns thoroughly with your Orthopaedic Surgeon prior to surgery.
Summary
Surgery is not a pleasant prospect for anyone, but for some people with arthritis, it could mean the difference between leading a normal life or putting up with a debilitating condition. Surgery can be regarded as part of your treatment plan it may help to restore function to your damaged joints as well as relieve pain. Surgery is only offered once non-operative treatment has failed. It is an important decision to make and ultimately it is an informed decision between you, your surgeon, family and GP. Although most people are extremely happy with their new knee, complications can occur and you must be aware of these prior to making a decision. If you are undecided, it is best to wait until you are sure this is the procedure for you.