IOA 2022

Pertrochanteric Calcifications in Patients with Greater Trochanteric Pain Syndrome: Description, Prevalence, and Correlation with Intraoperatively Diagnosed Hip Abductor Tendon Injuries

Phillip Rosinsky 1 Mitchell Yelton 1 Hari Ankem 1 Mitchell Meghpara 1,2 David Maldonado 1 Jacob Shapira 1 Brent Yelton 3 Ajay Lall 1,4 Benjamin Domb 1,4
1Orthopedics and Sports Medicine Research, American Hip Institute Research Foundation, USA
2Orthopedics, AMITA Health St. Alexius Medical Center, USA
3Orthopedics, Oakland University William Beaumont School of Medicine, USA
4Orthopedics, American Hip Institute, USA

Purpose:
(1) To describe the various types and prevalence of pertrochanteric calcifications in patients presenting for the surgical management of recalcitrant GTPS.

(2) To evaluate the association of the various calcifications with intraoperatively diagnosed hip abductor tendon injuries, including tendinosis, partial-thickness tears, and full-thickness tears.

Methods:
Patients undergoing surgical management for GTPS, in isolation or as an ancillary procedure during hip arthroscopy for femoroacetabular impingement, between April 2008 and February 2020 were included. Radiographs were scrutinized for the presence of pertrochanteric calcifications. The hip abductor tendon status was intraoperatively classified as intact, partial-thickness tear, or full-thickness tear. The prevalence and correlation of the various radiographic findings in relation to the intraoperatively classified tendon condition were analyzed via the odds ratio (OR).

Results:
Surgery was performed on 713 hips with recalcitrant GTPS. Radiographically, 102 hips (14.3%) demonstrated proximally directed enthesophytes, and 34 (4.8%) had distally directed enthesophytes. In addition, 75 hips (10.5%) had amorphous calcifications, 47 (6.6%) had isolated ossicles, and 110 (15.4%) had surface irregularities. The presence of any calcification was associated with partial-thickness tears (OR, 1.67 [95% CI, 1.21-2.21]; P = .002) and full-thickness tears (OR, 6.40 [95% CI, 3.91-10.47]; P < .001). Distally directed enthesophytes (OR, 10.18 [95% CI, 3.08-33.63]; P < .001) and proximally directed enthesophytes (OR, 8.69 [95% CI, 4.66-16.21]; P < .001) were the findings with the highest OR for the presence of any type of tear.

Conclusion:
Pertrochanteric calcifications were common radiographic findings in patients with GTPS and can help guide management in these patients. Proximally and distally directed enthesophytes were strong predictors for the presence of a hip abductor tendon tear, and specifically a full-thickness tear, and increasing size of the findings was associated with more severe tendon injuries.