Trochanteric reduction osteotomy for refractory greater trochanter painful syndrome.

Abstract

Conservative treatment is considered the gold standard for managing greater trochanteric pain syndrome (GTPS), with a reported success rate of 90%. However, when conservative measures fail, surgical intervention may be necessary. Various surgical techniques have been described, but consistent results remain elusive. This study aims to present our outcomes using trochanteric reduction osteotomy (TRO) as a rescue technique for refractory GTPS cases without gluteal tears. We retrospectively evaluated all cases of GTPS refractory to conservative treatment that were managed with isolated TRO at a single center. The Visual Analogue Scale (VAS), the Western Ontario and McMaster Universities Arthritis Index (WOMAC), and the Non-Arthritic Hip Score (NAHS) were assessed preoperatively and at the end of follow-up. Additionally, patients were asked if they were satisfied with the procedure and whether they would undergo the surgery again. Complications were also recorded. A total of 11 TROs were performed in 10 patients with a minimum follow-up of 3 years (3-5.5). The series comprised 90% women, with an average age of 49 years. The mean improvement of the scores was: VAS 5 (- 2/8) points; NAHS 29.24 (- 16/52) points; WOMAC 34.59 (- 40/63) improving in all 3 categories. All patients except one were satisfied with the outcomes. Complications occurred in 5 cases (45.5%), all requiring reoperation: 3 for osteosynthesis failure due to delayed healing, 1 for symptomatic pseudarthrosis, and 1 for a subtrochanteric fracture. Despite a high complication rate, the clinical outcomes at the end of follow-up are promising, with most patients reporting satisfaction. We believe this surgical option should be considered as part of the therapeutic arsenal for GTPS cases refractory to conservative treatment. Case series with no control group.