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Greater Trochanteric Bursa Excision 27062

 
CPT Technique
Indications Complications
Contraindications Follow-up Care / Rehab Protocol
Alternatives Outcomes
Pre-op Planning / Case Card Review References

synonyms:

 Greater Trochanteric Bursa Excision CPT

Greater Trochanteric Bursa Excision Indications

  • Hip bursitis which has failed > 6 months of conservative management

 Greater Trochanteric Bursa Excision Contraindications

  •  Active infection
  • Medically unstable patient

Greater Trochanteric Bursa Excision Alternatives

  • Steroid injection
  • Physical therapy
  • Activity modifications, NSAIDS

Greater Trochanteric Bursa Excision Pre-op Planning

  • Lateral decubitus positioning 

Greater Trochanteric Bursa Excision Technique

  • Sign operative site.
  • Pre-op antibiotics
  • Postioning - lateral on peg board/bean bag/hip positioners, axillary role, pad down leg, and all bony prominences.
  • Prep and drape in standard sterile fashion.
  • 3-7cm longitudinal ncision over greater trochanter
  • Incision to fascia lata, mark fascia lata with methylene blue for later repair
  • Clear bursal tissue.
  • Palpate greater trochanteric and remove any calcifications or bony prominences with rongeur.
  • Consider relaxing the ITB: proximal Z-plasty, proximal longitudinal release, and distal Z-plasty.
  • Repair fascia lata with running barbed suture
  • Close in layers.

Greater Trochanteric Bursa Excision Complications

Greater Trochanteric Bursa Excision Follow-up care

  • Post-op: Weight bearing as tolerated.  Avoid any pressue on operative site. 
  • 7-10 Days:Wound check.  Avoid any pressure on operative site. 
  • 3 Weeks: Gradually resume normal activities as tolerated. 

Greater Trochanteric Bursa Excision Outcomes

  • 88%-100% pain relief

Greater Trochanteric Bursa Excision Review References

  • Karpinski M, Piggott H. Greater trochanteric pain syndrome. A report of 15 cases. J Bone Joint Surg Br. 1985;67:762–763.  [PubMed]
  • Radin E. Biomechanics of the human hip. Clin Orthop Relat Res. 1980;152:28–34.  [PubMed]
  • Bunker T, Esler C, Leach W. Rotator-cuff tear of the hip. J Bone Joint Surg Br. 1997;79:618–620.  [PubMed]
  • Wright J, Swiontkowski M, Heckman J. Introducing levels of evidence to the journal. J Bone Joint Surg Am. 2003;85:1–3.  [PubMed]
  • Farmer K, Jones L, Brownson K, et al. Trochanteric bursitis after total hip arthroplasty. J Arthroplasty. 2010;25:208–212.  [PubMed]
  • Furia J, Rompe J, Maffulli N. Low-energy extracorporeal shock wave therapy as a treatment for greater trochanteric pain syndrome. Am J Sports Med. 2009;37:1806–1813.  [PubMed]
  • Govaert L, van der Vis H, Marti R, et al. Trochanteric reduction osteotomy as a treatment for refractory trochanteric bursitis. J Bone Joint Surg Br. 2003;85:199–203.  [PubMed]
  • Iorio R, Healy W, Warren P, et al. Lateral trochanteric pain following primary total hip arthroplasty. J Arthroplasty. 2006;21:233–236.  [PubMed]
  • Rompe J, Segal N, Cacchio A, et al. Home training, local corticosteroid injection, or radial shock wave therapy for greater trochanteric pain syndrome. Am J Sports Med. 2009;37:1981–1990.  [PubMed]
  • Slawski D, Howard R. Surgical management of refractory trochanteric bursitis. Am J Sports Med. 1997;25:86–89.  [PubMed]
  • Baker CJ, Massie R, Hurt W, et al. Arthroscopic bursectomy for recalcitrant trochanteric bursitis. Arthroscopy. 2007;23:827–832.  [PubMed]
  • Kagan A. Rotator cuff tears of the hip. Clin Orthop Relat Res. 1999;368:135–140.  [PubMed]
  • Lequesne M, Djian P, Vuillemin V, et al. Prospective study of refractory greater trochanter pain syndrome. MRI findings of gluteal tendon tears seen at surgery. Clinical and MRI results of tendon repair. Joint Bone Spine. 2008;75:458–464.  [PubMed]
  • Voos J, Shindle M, Pruett A, et al. Endoscopic repair of gluteus medius tendon tears of the hip. Am J Sports Med. 2009;37:743–747.  [PubMed]
  • Davies H, Zhaeentan S, Tavakkolizadeh A, et al. Surgical repair of chronic tears of the hip abductor mechanism. Hip Int. 2009;19:372–376.  [PubMed