Abductor tendon tear and bursitis after total hip arthroplasty

Case contributed by Dr Reto Sutter

Presentation

Intermittent pain in the left gluteal area and limping 6 years after total hip arthroplasty (THA).

Patient Data

Age: 59 years
Gender: Male
MRI

Artifact-reduced MRI of the left hip

Extensive abductor tendon tear at the greater trochanter: the gluteus minimus tendon and the lateral portion of gluteus medius tendon are retracted, with a gap visible between the greater trochanter and the tendons on the STIR sequence

Trochanteric bursitis with area of high STIR signal intensity lateral to greater trochanter 

Fatty muscle degeneration and atrophy of the gluteus minimus and gluteus medius muscle on T1-weighted sequence

Hip arthroplasty: without periprosthetic fracture or adjacent bone marrow oedema. However, there is communication between the trochanteric bursitis and the joint effusion

Case Discussion

Tearing of the abductor tendons and trochanteric bursitis are a common cause of greater trochanteric pain syndrome after total hip arthroplasty (THA). In this case the tendons are retracted and no longer attached to the greater trochanter. There is substantial fatty degeneration of the affected muscles, indicating that this is a chronic condition.

Technical considerations:
In patients with THA metal artifact reduction sequences (MARS) should be used for MRI. The coronal STIR sequence was acquired with the Slice-Encoding for Metal Artifact Correction (SEMAC) technique that addresses both in-plane and through-plane metal artifacts. This sequence allows to detect findings at the bone-metal-interface such as bone marrow edema. Note that in this case the bone-metal-interface is normal. Moreover, the STIR SEMAC sequence is also useful for detection of soft tissue pathology, such as in this case.
The axial T1-weighted sequence was acquired with an increased readout bandwidth, which is a simple but powerful method in order to reduce metal artifacts in non-fat-suppressed images.

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Case information

rID: 35468
Case created: 7th Apr 2015
Last edited: 14th Sep 2015
Inclusion in quiz mode: Included

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