Trochanteric bursitis is reported to occur in up to 17% of hips after THA and may be related to the surgical approach [144,145]. CT Hip CT is less optimal than MRI for assessing soft tissues [22]. Fractures and fluid collections can be identified on CT. Image-Guided Anesthetic +/- Corticosteroid Injection Hip Joint or Surrounding Structures If trochanteric bursitis is thought to be a source of pain, Robbins et al [144] suggest the bursa may be injected with either lidocaine alone as a diagnostic test, or in combination with a corticosteroid as a therapeutic measure. MRI Hip MRI can be used to assess peritrochanteric structures including the gluteus minimus and medius muscles, abductor tendons, and the trochanteric bursa [146,147]. There is no relevant literature documenting the additional benefit of MRI with IV contrast, relative to noncontrast MRI, in this population. Pfirrmann et al [147] compared the MRI findings about the greater trochanter in 25 patients after primary THA without pain and 39 patients with trochanteric pain and abductor weakness. Although several abnormalities were seen in both symptomatic and asymptomatic groups, defects of the abductor tendons and fatty atrophy of the gluteus medius muscle and the posterior part of the gluteus minimus muscle were uncommon in asymptomatic patients. Comparison of MRI findings with findings at surgical revision in 14 patients confirmed all MRI tendon findings. Joint distension and decompression of synovitis into the greater trochanteric bursa and fluid undermining the hip abductors can be assessed on MARS-MRI [72]. Weber et al [141] noted that extracapsular disease associated with ARMD could be misinterpreted as trochanteric bursitis. Radiographic Arthrography Hip Weakness or detachment of the abductor muscles may occur after THA using an anterolateral approach [148].
Imaging after Total Hip Arthroplasty PCAs. Trochanteric bursitis is reported to occur in up to 17% of hips after THA and may be related to the surgical approach [144,145]. CT Hip CT is less optimal than MRI for assessing soft tissues [22]. Fractures and fluid collections can be identified on CT. Image-Guided Anesthetic +/- Corticosteroid Injection Hip Joint or Surrounding Structures If trochanteric bursitis is thought to be a source of pain, Robbins et al [144] suggest the bursa may be injected with either lidocaine alone as a diagnostic test, or in combination with a corticosteroid as a therapeutic measure. MRI Hip MRI can be used to assess peritrochanteric structures including the gluteus minimus and medius muscles, abductor tendons, and the trochanteric bursa [146,147]. There is no relevant literature documenting the additional benefit of MRI with IV contrast, relative to noncontrast MRI, in this population. Pfirrmann et al [147] compared the MRI findings about the greater trochanter in 25 patients after primary THA without pain and 39 patients with trochanteric pain and abductor weakness. Although several abnormalities were seen in both symptomatic and asymptomatic groups, defects of the abductor tendons and fatty atrophy of the gluteus medius muscle and the posterior part of the gluteus minimus muscle were uncommon in asymptomatic patients. Comparison of MRI findings with findings at surgical revision in 14 patients confirmed all MRI tendon findings. Joint distension and decompression of synovitis into the greater trochanteric bursa and fluid undermining the hip abductors can be assessed on MARS-MRI [72]. Weber et al [141] noted that extracapsular disease associated with ARMD could be misinterpreted as trochanteric bursitis. Radiographic Arthrography Hip Weakness or detachment of the abductor muscles may occur after THA using an anterolateral approach [148].