Trochanteric Bursa Repair Enters the Hemiarthroplasty Question in Older Adults
A prospective randomized trial is set to test a deceptively simple surgical question: does repairing the trochanteric bursa after hip hemiarthroplasty reduce lateral hip pain in older adults with femoral neck fracture? The study will enroll 102 patients aged 65 years and older undergoing primary hemiarthroplasty for acute intracapsular femoral neck fractures, with half assigned to bursa repair and half to leaving the bursa unrepaired. The main outcome is pain when lying on the operated side six weeks after surgery, measured on an 11-point numerical rating scale.
This is a clinically grounded problem. Patients recovering from hip fracture surgery often care less about radiographic alignment than about whether they can sleep on the repaired side, transfer without a sharp ache over the greater trochanter, and regain enough comfort to move through rehabilitation. The bursa sits over that bony prominence and acts as a gliding interface between bone and soft tissues. When the posterior approach opens the tissue, the question becomes whether meticulous anatomical closure reduces postoperative irritation or whether the additional repair adds little to recovery.
A single sentence captures the entire premise: persistent lateral hip pain after surgery can derail rehabilitation long after the fracture itself has been stabilized.
Why Bursa Management Could Change Early Recovery
The protocol focuses on a mechanism that is easy to understand at the bedside. If the bursa is left disrupted after surgical exposure, friction over the greater trochanter may continue to generate pain during side-lying and daily activity. In contrast, re-establishing the soft tissue layer with sutures could restore a smoother gliding surface and blunt local irritation during the first weeks of healing. The trial does not excise the bursa in either arm, and both groups follow the same capsular and short external rotator repair, implant selection, postoperative analgesia, mobilization, and rehabilitation pathways.
The study’s surgical technique is tightly specified. Patients randomized to the intervention arm will receive anatomical repair of the longitudinally opened bursa using three to four interrupted sutures with No. 1 Vicryl. Those assigned to the control arm will have the bursa left unrepaired after the same longitudinal opening. Randomization will occur only after the operating surgeon confirms that the bursa is suitable for primary repair, which means the comparison is being made within a technically eligible subset rather than all comers.
The design also reflects a practical compromise around blinding. The operating team cannot remain blinded after allocation, but postoperative physiotherapists, outpatient assessors, and radiographic readers will remain blinded to treatment assignment. Complete participant blinding cannot be guaranteed, which is unsurprising in a trial where sutures either are or are not placed in an identifiable soft tissue layer.
Pain at Six Weeks Sits at the Center of the Protocol
The primary endpoint is deliberately narrow: lateral trochanteric pain while lying on the operated side at six weeks. That choice matters because side-lying pain is one of the clearest patient-centered signals of ongoing peritrochanteric irritation. It is also a symptom that can influence nighttime rest, willingness to mobilize, and tolerance of rehabilitation exercises. The 0-to-10 scale gives the study a direct readout of whether the repair changes the lived experience of recovery rather than only the surgeon’s impression of the closure.
Secondary assessments extend the picture into function and complications. Investigators will track pain during daily activities, pain on trochanteric palpation, ability to lie on the operated side, mobility using the Turkish version of the Cumulated Ambulation Score, and independence using the Modified Barthel Index. Intraoperative and postoperative complications are also part of the outcome set, along with early delirium and cognitive screening through the Standardized Mini-Mental Test and 4AT.
Short follow-up intervals are built into the schedule. Assessments will occur at 2, 4, and 6 weeks and again at 3 months after surgery, with postoperative day 1 mobilization status and day 2 mobility, delirium screening, and early complications recorded separately. This sequence should capture the period when wound-related and soft tissue pain are most likely to influence how quickly an older patient resumes walking and self-care.
Statistical Design Reflects a Small but Focused Surgical Trial
The planned sample size is 102 participants, based on 51 per group. Investigators assumed a between-group difference of 1.0 point on the pain scale and a common standard deviation of 1.4, with 90% power and a two-sided alpha of 0.05. Those assumptions were extrapolated from total hip arthroplasty literature using visual analogue scales, not directly observed six-week numerical rating scale data from this hemiarthroplasty population.
Because the trial is expected to contend with real-world postoperative limitations, the analysis plan is careful about missing data. Participants who die, cannot lie on the operated side, or cannot provide a reliable pain score at six weeks will be documented without inventing pain values. The primary analysis will compare evaluable participants according to randomized assignment, with mean differences, 95% confidence intervals, and two-sided p-values reported. Mixed-effects models will be used for repeated pain and function measures, and prespecified covariates include age, sex, pre-fracture mobility, comorbidity burden, and cemented versus uncemented stem status.
A supporting adjusted model will sit beside the primary unadjusted analysis, not in place of it. The design keeps the core comparison anchored to randomization while still allowing clinically sensible adjustment for factors that can shape postoperative pain and mobility in older fracture patients.
What This Trial Could Clarify for Hip Fracture Surgery
Hip fracture care often prioritizes survival, mobilization, and discharge planning, yet persistent lateral pain can quietly slow all three. If bursa repair lowers side-lying pain at six weeks, it would support a low-cost intraoperative step with no new device, no additional implant, and no change in postoperative rehabilitation pathways. If there is no meaningful difference, surgeons may gain confidence that leaving the bursa unrepaired does not worsen this specific source of postoperative discomfort.
Either outcome would be useful because the current evidence base is thin for hemiarthroplasty in older adults with femoral neck fracture. Prior work has largely focused on trochanteric bursa management during total hip arthroplasty, leaving this narrower and more vulnerable population without direct evidence. The trial’s single-center structure and assessor-blinded design should keep the comparison clean, but the results will still need to be interpreted within the boundaries of one hospital, one operative approach, and a relatively small sample.
For now, the study asks a precise surgical question with an equally precise symptom target. The major unanswered issue is whether soft tissue repair over the greater trochanter changes enough early pain to matter in a frail fracture population moving through the first weeks after surgery.