Guidance

2 The procedure

2 The procedure

2.1 Indications and current treatments

2.1.1

Greater trochanteric pain syndrome is a disorder that affects the (lateral) side of the hip or hips. Greater trochanteric pain may be associated with inflammation of the trochanteric bursa (also known as trochanteric bursitis). The trochanteric bursa is a small fluid-filled sac that separates the greater trochanter of the femur and the overlying fascia lata to allow smooth movement. Greater trochanteric pain may also be associated with direct injury, tendon damage, infection, differences in leg length or hip-replacement surgery.

2.1.2

Greater trochanteric pain syndrome is usually managed conservatively with rest, physiotherapy, anti-inflammatory medication and corticosteroid injections. In patients refractory to conservative treatment, surgical options such as bursectomy or supratrochanteric fasciotomy may be used.

2.2 Outline of the procedure

2.2.1

The aim of distal iliotibial band lengthening for refractory greater trochanteric pain syndrome is to relieve the pressure between the greater trochanter and the fascia lata by lengthening the iliotibial band (a thickened and reinforced part of the fascia lata which runs longitudinally throughout its length).

2.2.2

Distal iliotibial band lengthening for greater trochanteric pain syndrome is carried out with the patient under local or general anaesthesia. Through a short lateral incision above the knee a 'Z' lengthening of the iliotibial band of approximately 1.5 cm to 2 cm is performed. The fascia is repaired with sutures.

2.3 Efficacy

This section describes efficacy outcomes from the published literature that the committee considered as part of the evidence about this procedure. For more detailed information on the evidence, see the overview.

2.3.1

A case series of 11 patients reported a mean Harris hip score of 61 before the procedure and 91 at a mean 43-month follow-up (the Harris hip score measures functional ability, hip dynamics and range of movement on a scale from 0 to 100, in which a higher score indicates a better health outcome).

2.3.2

The case series of 11 patients reported a mean pain score (measured on a scale from 0 to 100; a higher score indicates worse pain) of 83 before the procedure and 13 at a mean follow-up of 43 months.

2.3.3

A case series of 12 patients reported a significant increase in mean EQ-5D score (a standardised assessment of mobility, self care, usual activities, pain and/or discomfort and anxiety and/or depression; a higher score indicates a better health outcome) from 0.26 before the procedure to 0.67 at a mean 28-month follow-up (p<0.005).

2.3.4

The specialist advisers expressed doubt about the conceptual mechanism of action of this procedure. They listed key efficacy outcomes as pain relief, patient satisfaction, hip function (measured using the isokinetic strength Harris hip score) and quality of life (measured using SF-36 or Euroqol scores).

2.4 Safety

This section describes safety outcomes from the published literature that the committee considered as part of the evidence about this procedure. For more detailed information on the evidence, see the overview.

2.4.1

Seroma was reported in 1 patient in the case series of 11 patients (timing of event not stated); this was successfully treated by surgical drainage.

2.4.2

The specialist advisers considered that loss of strength in the lower limb was a theoretical adverse event.