CHAPTER 16 Arthroscopic Iliotibial Band Lengthening and Bursectomy for Recalcitrant Trochanteric Bursitis and Coxa Saltans Externa
Indications
Operative intervention is indicated for the following patients:
Surgical technique
Our preferred surgical technique for recalcitrant trochanteric bursitis is an arthroscopic trochanteric bursectomy. Patients are positioned in the lateral decubitus position with the affected extremity facing up. A deflatable beanbag is used to stabilize the patient, and all bony prominences are well padded. The leg is draped freely so that the hip can be taken through a full range of motion (Figure 16-1). The greater trochanter is palpated and outlined on the skin with a marker. A spinal needle is then inserted directly onto the trochanteric prominence. The needle is then withdrawn slightly by several millimeters, and approximately 30 mL to 40 mL of normal saline is injected into the bursa, thus creating a space underneath the ITB. We prefer to leave the needle in for the purpose of localization. Next, a proximal portal is created 2 cm to 3 cm proximal to the trochanter, and a distal portal is created 2 cm to 3 cm distal to the trochanter. The skin is incised in line with the long axis of the femur. A 4-mm, 30-degree arthroscope is introduced directly into the subcutaneous tissues above the ITB. A 4.5-mm shaver is placed in the other portal and localized to the arthroscope with a triangulation technique (Figure 16-2). The fat directly above the ITB is removed to allow for full visualization of the ITB (Figure 16-3). An arthroscopic ablation probe can also be used to maintain hemostasis and concurrently to remove adherent tissues.
Figure 16–1 The patient is positioned in the lateral decubitus position, with the entire hip and leg draped free.