The Archives of Bone and Joint Surgery

The Archives of Bone and Joint Surgery

Risk Factors for Lateral Trochanteric Pain Following Anterior Approach Total Hip Arthroplasty

Document Type : RESEARCH PAPER

Authors
Rex W. Lutz 1
Danielle Y. Ponzio 2
Hope S. Thalody 2
Qudratullah S. Qadiri 2
Alvin C. Ong 2
Zachary D. Post 2
1 Jefferson Health New Jersey, Stratford, NJ, USA
2 Rothman Orthopaedic Institute, Egg Harbor Township, NJ, USA
10.22038/abjs.2024.74576.3456
Abstract
Objectives: The principal aim of our study is to investigate risk factors for lateral trochanteric pain (LTP) 
after direct anterior approach (DAA) primary total hip arthroplasty (THA).
Methods: A retrospective case control study was developed from 542 patients who underwent primary THA over a 
9-year period to form two patient cohorts. Two hundred and seventy-one patients diagnosed with LTP were matched 
with 271 controls. Chart review revealed patient demographics, surgical approach, and femoral components utilized. 
Change in limb length and offset were assessed through preoperative and postoperative radiographic 
measurements.
Results: There was a higher proportion of current or former smokers in the LTP group (34.5% vs 21.74%, p=0.003). 
There was no significant difference in use of high offset stems vs. standard offset stems between groups (15.9% vs. 
18.5%, p=0.494). However, the LTP group had significantly higher increase in both femoral offset (+3.55mm vs 
+1.79mm, p<0.001) and total offset (+0.16mm vs -1.16mm, p=0.031) in comparison to controls.
Conclusion: An increase in total offset, femoral offset, and smoking history are factors associated with LTP after 
DAA primary THA.
 Level of evidence: I
Keywords
DAA
Direct anterior approach
Femoral offset
Lateral trochanteric pain
THA
Subjects
  1. Learmonth ID, Young C, Rorabeck C. The operation of the century: total hip replacement. Lancet. 2007; 370:1508–19. doi:10.1016/S0140-6736(07)60457-7.
  2. Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007; 89:780–5. doi: 10.2106/JBJS.F.00222.
  3. Kelmer G, Stone AH, Turcotte J, King PJ. Reasons for Revision: Primary Total Hip Arthroplasty Mechanisms of Failure. J Am Acad Orthop Surg. 2021; 29:78–87. doi: 10.5435/JAAOS-D-19-00860.
  4. Sayed-Noor AS, Sjoden GO. Greater trochanteric pain after total hip arthroplasty: the incidence, clinical outcome and associated factors. Hip Int. 2006; 16:202–6. doi: 10.1177/112070000601600304.
  5. Moerenhout K, Benoit B, Gaspard HS, Rouleau DM, Laflamme GY. Greater trochanteric pain after primary total hip replacement, comparing the anterior and posterior approach: A secondary analysis of a randomized trial. Orthop Traumatol Surg Res. 2021; 107:102709. doi: 10.1016/j.otsr.2020.08.011.
  6. Skibicki HE, Brustein JA, Orozco FR, Ponzio DY, Post ZD, Ong AC. Lateral Trochanteric Pain Following Primary Total Hip Arthroplasty: Incidence and Success of Nonoperative Treatment. J Arthroplasty. 2021; 36:193–9. doi: 10.1016/j.arth.2020.07.043.
  7. Abdulkarim A, Keegan C, Bajwa R, Sheehan E. Lateral trochanteric pain following total hip arthroplasty: radiographic assessment of altered biomechanics as a potential aetiology. Ir J Med Sci. 2018; 187:663–8. doi: 10.1007/s11845-017-1701-1.
  8. Iorio R, Healy WL, Warren PD, Appleby D. Lateral trochanteric pain following primary total hip arthroplasty. J Arthroplasty. 2006; 21:233–6. doi: 10.1016/j.arth.2005.03.041.
  9. Worlicek M, Messmer B, Grifka J, Renkawitz T, Weber M. Restoration of leg length and offset correlates with trochanteric pain syndrome in total hip arthroplasty. Sci Rep. 2020; 10:7107. doi: 10.1038/s41598-020-62531-9.
  10. Fearon AM, Cook JL, Scarvell JM, Neeman T, Cormick W, Smith PN. Greater trochanteric pain syndrome negatively affects work, physical activity and quality of life: a case control study. J Arthroplasty. 2014; 29:383–6. doi: 10.1016/j.arth.2012.10.016.
  11. Kagan A. Rotator cuff tears of the hip. Clin Orthop Relat Res. 1999:135–40.
  12. Pfirrmann CWA, Notzli HP, Dora C, Hodler J, Zanetti M. Abductor Tendons and Muscles Assessed at MR Imaging after Total Hip Arthroplasty in Asymptomatic and Symptomatic Patients. Radiology. 2005; 235:969–76. doi: 10.1148/radiol.2353040403.
  13. Farmer KW, Jones LC, Brownson KE, Khanuja HS, Hungerford MW. Trochanteric Bursitis after Total Hip Arthroplasty: Incidence and Evaluation of Response to Treatment. J Arthroplasty. 2010; 25:208–12. doi: 10.1016/j.arth.2009.02.008.
  14. Shemesh SS, Moucha CS, Keswani A, Maher NA, Chen D, Bronson MJ. Trochanteric Bursitis Following Primary Total Hip Arthroplasty: Incidence, Predictors, and Treatment. J Arthroplasty .2018; 33:1205–9. doi: 10.1016/j.arth.2017.11.016.
  15. Schwartsmann CR, Loss F, de Freitas Spinelli L, et al. Association between trochanteric bursitis, osteoarthrosis and total hip arthroplasty. Rev Bras Ortop. 2014; 49:267–70. doi: 10.1016/j.rboe.2014.04.009.
  16. Charnley J. Total hip replacement by low-friction arthroplasty. Clin Orthop Relat Res. 1970; 72:7–21.
  17. Charles MN, Bourne RB, Davey JR, Greenwald AS, Morrey BF, Rorabeck CH. Soft-tissue balancing of the hip: the role of femoral offset restoration. Instr Course Lect. 2005; 54:131–41.
  18. Sakalkale DP, Sharkey PF, Eng K, Hozack WJ, Rothman RH. Effect of femoral component offset on polyethylene wear in total hip arthroplasty. Clin Orthop Relat Res. 2001:125–34. doi: 10.1097/00003086-200107000-00019.
  19. Incavo SJ, Havener T, Benson E, McGrory BJ, Coughlin KM, Beynnon BD. Efforts to improve cementless femoral stems in THR: 2- to 5-year follow-up of a high-offset femoral stem with distal stem modification (Secur-Fit Plus). J Arthroplasty. 2004; 19:61–7. doi: 10.1016/j.arth.2003.09.006.
  20. Liebs TR, Nasser L, Herzberg W, Rüther W, Hassenpflug J. The influence of femoral offset on health-related quality of life after total hip replacement. Bone Joint J. 2014; 96-B: 36–42. doi: 10.1302/0301-620X.96B1.31530.
  21. Sayed-Noor AS, Pedersen E, Wretenberg P, Sjödén GO. Distal lengthening of ilio-tibial band by Z-plasty for treating refractory greater trochanteric pain after total hip arthroplasty (Pedersen-Noor operation). Arch Orthop Trauma Surg. 2009; 129:597–602. doi: 10.1007/s00402-008-0693-8.
  22. Cassidy KA, Noticewala MS, Macaulay W, Lee JH, Geller JA. Effect of femoral offset on pain and function after total hip arthroplasty. J Arthroplasty. 2012; 27:1863–9. doi: 10.1016/j.arth.2012.05.001.
  23. Austin MS, Hozack WJ, Sharkey PF, Rothman RH. Stability and leg length equality in total hip arthroplasty. J Arthroplasty. 2003; 18:88–90. doi: 10.1054/arth.2003.50073.
  24. Williamson JA, Reckling FW. Limb Length Discrepancy and

 

Related Problems Following Total Hip Joint Replacement. Clin Orthop Relat Res. 1978 ;( 134):135-8.

  1. Al-Amiry B, Mahmood S, Krupic F, Sayed-Noor A. Leg lengthening and femoral-offset reduction after total hip arthroplasty: where is the problem - stem or cup positioning? Acta Radiol. 2017; 58:1125–31. doi: 10.1177/0284185116684676.
  2. Husby VS, Bjørgen S, Hoff J, Helgerud J, Benum P, Husby OS. Unilateral vs. bilateral total hip arthroplasty - the influence of medial femoral head offset and effects on strength and aerobic endurance capacity. Hip Int. 2010; 20:204–14. doi: 10.1177/112070001002000211.
  3. Yamaguchi T, Naito M, Asayama I, Ishiko T. Total hip arthroplasty: the relationship between posterolateral reconstruction, abductor muscle strength, and femoral offset. J Orthop Surg. 2004; 12:164–7. doi: 10.1177/230949900401200205.
  4. Asayama I, Chamnongkich S, Simpson KJ, Kinsey TL, Mahoney OM. Reconstructed hip joint position and abductor muscle strength after total hip arthroplasty. J Arthroplasty. 2005; 20:414–20. doi: 10.1016/j.arth.2004.01.016.
  5. Kiyama T, Naito M, Shinoda T, Maeyama A. Hip Abductor Strengths After Total Hip Arthroplasty Via the Lateral and Posterolateral Approaches. J Arthroplasty. 2010; 25:76–80. doi: 10.1016/j.arth.2008.11.001.
  6. McGrory BJ, Morrey BF, Cahalan TD, An KN, Cabanela ME. Effect of femoral offset on range of motion and abductor muscle strength after total hip arthroplasty. J Bone Joint Surg Br. 1995; 77:865–9.
  7. Malik A, Maheshwari A, Dorr LD. Impingement with total hip replacement. J Bone Joint Surg Am. 2007; 89:1832–42. doi: 10.1016/j.cuor.2008.10.009.
  8. Matsushita A, Nakashima Y, Jingushi S, Yamamoto T, Kuraoka A, Iwamoto Y. Effects of the femoral offset and the head size on the safe range of motion in total hip arthroplasty. J Arthroplasty .2009; 24:646–51. doi: 10.1016/j.arth.2008.02.008.
  9. Patel AB, Wagle RR, Usrey MM, Thompson MT, Incavo SJ, Noble PC. Guidelines for implant placement to minimize impingement during activities of daily living after total hip arthroplasty. J Arthroplasty. 2010; 25:1275-81.e1. doi: 10.1016/j.arth.2009.10.007.
  10. Kurtz WB, Ecker TM, Reichmann WM, Murphy SB. Factors affecting bony impingement in hip arthroplasty. J Arthroplasty. 2010; 25:624-34.e1-2. doi: 10.1016/j.arth.2009.03.024.
  11. Liebs TR, Nasser L, Herzberg W, Ruther W, Hassenpflug J. The influence of femoral offset on health-related quality of life after total hip replacement. Bone Joint J. 2014; 96-B (1):36-42. doi: 10.1302/0301-620X.96B1.31530.
  12. Lee JJ, Patel R, Biermann JS, Dougherty PJ. The musculoskeletal effects of cigarette smoking. J Bone Joint Surg Am. 2013; 95:850–9. doi: 10.2106/JBJS.L.00375.
  13. Weber M, Woerner ML, Springorum H-R, Hapfelmeier A, Grifka J, Renkawitz TF. Plain radiographs fail to reflect femoral offset in total hip arthroplasty. J Arthroplasty. 2014; 29:1661–5. doi: 10.1016/j.arth.2014.03.023.

 

 

 

 

The Archives of Bone and Joint Surgery
Volume 12, Issue 9
September 2024
Pages 631-636

  • Receive Date 27 September 2023
  • Revise Date 03 July 2024
  • Accept Date 15 June 2024