Lateral Trochanteric Pain Following Primary Total Hip Arthroplasty: Incidence and Success of Non-Operative Treatment

Abstract Introduction Our study aimed to quantify the overall incidence of lateral trochanteric pain (LTP) following total hip arthroplasty (THA) and risk based on surgical approach. The success of conservative treatment and potential risk factors for failure of conservative treatment were evaluated. Methods This was a retrospective review of patients who underwent primary THA between 2010-2019 and had a post-operative diagnosis of ipsilateral LTP. Chart review revealed patient demographics/comorbidities, pre-operative diagnosis, surgical approach, femoral components, and non-operative treatment modalities. Radiographic analysis was performed to measure leg length discrepancy, femoral offset, and femoral head lateralization. Results The incidence of LTP following primary THA was 1.70% (573/33,761) with an average time to diagnosis of 27.3 months. The direct anterior approach demonstrated the highest risk and the direct lateral demonstrated the lowest risk for LTP(p 16.6% (95/573) were treated with physical therapy, home exercises, or oral medications with a success rate of 96.8% (92/95). 83.4% (478/573) were treated with corticosteroid injection (CSI). 89.5% (428/478) of the CSI cohort demonstrated clinical improvement with three or less CSIs. Risk factors for failure of conservative treatment were depression (p=0.034), kidney disease (p=0.040), and osteoporosis (p=0.007). Conclusion Post-operative LTP after THA is rare with an incidence of 1.70%. The direct anterior approach presented higher risk for LTP. Non-CSI modalities and CSIs were both successful treatment options. In patients with depression, kidney disease, and osteoporosis, conservative treatment may be less efficacious.