Bursa; Tuberculous, Deep Gluteal Syndrome, Hip Bursitis, Hip Disease
Conditions
Keywords
bursa, greater trochanter, hip arthroplasty, deep gluteal syndrome, piriformis syndrome
Brief summary
During total hip arthroplasty surgery, the trochanteric bursa is routinely excised. This anatomical structure, which functions as a soft tissue barrier, is generally recommended for removal as it facilitates the surgical approach. However, recent studies have suggested that the trochanteric bursa is an important soft tissue barrier and may protect against infections. The aim of this study is to evaluate the differences in infection rates, wound complications, deep gluteal syndrome presence, pain, and clinical scores within the first 90 days between patients in whom the trochanteric bursa was repaired and those in whom it was not, and to provide recommendations regarding bursal repair.
Detailed description
During total hip arthroplasty surgery, the trochanteric bursa is routinely excised. This anatomical structure, which functions as a soft tissue barrier, is typically recommended for removal as it facilitates the surgical approach. However, recent studies have suggested that the trochanteric bursa is an important soft tissue barrier and may provide protection against infections. The aim of this study is to evaluate the differences in infection rates, wound complications, deep gluteal syndrome presence, pain, and clinical scores within the first 90 days between patients in whom the trochanteric bursa was repaired and those in whom it was not, and to provide recommendations regarding bursal repair. This research will be a prospective randomized controlled trial with patients subjected to sequential randomization. One group of patients will undergo the routine excision of the bursa during surgery, referred to as Group 1. In the other group, the trochanteric bursa will be carefully retracted and subsequently repaired in its anatomical location beneath the fascia after the surgical procedure. Wound closure will be performed routinely, with subcutaneous and skin closure. All patients will have a Hemovac drain placed, and they will follow the same rehabilitation protocol. Patients will be evaluated on postoperative days15, 30, and 90 using Visual Analog Scale scores, and on days 30 and 90 using the Harris Hip Score. Additionally, patients will be assessed for tenderness on palpation, the presence of hip snapping (a sensation of the hip catching), hemoglobin drop, 90-day infection rates, and the presence of deep gluteal syndrome.
Interventions
PROCEDURETrochanteric bursa repaired
As a routine procedure in our centre, the trochanteric bursa is left unrepaired after a hip arthroplasty.
PROCEDURETrochanteric bursa unrepaired
For the experimental arm, the trochanteric bursa is repaired after a hip arthroplasty. The conventional joint closure is performed after reduction and then the bursa is retrieved and repaired.
Sponsors
Ankara City Hospital Bilkent
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
Randomized controlled trial
Eligibility
Sex/Gender
ALL
Age
18 Years to 90 Years
Healthy volunteers
No
Inclusion criteria
* Patients between 18 to 90 years of age * With a diagnosis of primary hip osteoarthritis * Willing to be included in the study
Exclusion criteria
* Patients who had a known history of trochanteric bursitis, deep gluteal syndrome, sciatica, vertebral fracture, hip fracture, hip arthroscopy, and core decompression surgery * Patients who had a history of bursal injection within 6 months * Patients undergoing hip arthroplasty with a shortening osteotomy
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Rate of superficial wound problems | First postoperative 90 days | Wound leakage, superficial infection, wound dehiscence - Recorded as Yes / No |
| Rate of posterior gluteal pain | First postoperative 90 days | The condition is also refered to as Deep Gluteal Syndrome - Recorded as Yes / No |
| Rate of painful trochanteric bursitis | First postoperative 90 days | Recorded as pain on the trochanteric region on palpation - Recorded as Yes / No |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Range of motion (ROM) | First postoperative 90 days | Angular measurement of hip joint motion - minimum value:0, maximum value 130, higher values mean better outcome |
| Visual Analog Scale (VAS) | First postoperative 90 days | minimum value:0, maximum value 10, higher values mean worse outcome |
| Harris Hip Score (HHS) | First postoperative 90 days | minimum value:0, maximum value 100, higher values mean better outcome |
Countries
Turkey (Türkiye)
Outcome results
None listed