Trochanteric bursitis: refuting the myth of inflammation
Fernando Silva1, Thomas Adams, Jeffery Feinstein
1Wilford Hall Medical Center, Lackland AFB, Texas, USA. fernando.silva@lackland.af.mil
Summary
Histologic evaluation of trochanteric pain syndrome suggests bursal inflammation is not the cause. This study found no signs of inflammation in bursal tissue, challenging the traditional understanding of greater trochanteric pain.
Area of Science:
- Orthopedics
- Rheumatology
- Pathology
Background:
- Greater trochanteric (GT) bursitis is a common source of hip pain.
- Traditionally attributed to subgluteus maximus bursa inflammation.
- Recent imaging studies question bursitis as the primary cause of trochanteric pain.
Purpose of the Study:
- To histologically evaluate bursal tissue in patients with and without clinical GT bursitis.
- To assess for the presence of bursal inflammation as an etiology for trochanteric pain syndrome.
- To provide the first reported histologic data on GT bursitis.
Main Methods:
- Prospective, case-controlled, blinded histopathologic study.
- Recruited patients undergoing total hip arthroplasty (THA) for osteoarthritis or rheumatoid arthritis.
- Bursal specimens from 5 patients (2 with GT bursitis, 3 controls) were examined by blinded pathologists.
Main Results:
- Bursal specimens showed primarily fibroadipose tissue.
- No signs of acute or chronic inflammation were observed.
- No significant differences in histopathology were found between the GT bursitis group and the control group.
Conclusions:
- Histologic findings suggest bursal inflammation is not the etiology of trochanteric pain syndrome.
- These findings align with recent MRI and ultrasound studies.
- The study indicates a need to re-evaluate the understanding of GT pain causation.
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