Arthroscopic Treatment of Symptomatic Internal Snapping Hip with Combined Pathologies

Abstract

Background: Arthroscopic iliopsoas tendon release was introduced in 2000. The purpose of this study was to evaluate clinical outcomes of arthroscopic iliopsoas tendon release for painful internal snapping hip with concomitant hip pathologies.

Methods: Between January 2009 and December 2011, we performed arthroscopic iliopsoas tendon release and related surgeries in 25 patients (20 men and 5 women; mean age, 32 years; range, 17 to 53 years) with combined intraarticular hip pathologies. The patients were followed for a minimum of 2 years postoperatively. Clinical and radiological evaluations were performed.

Results: Snapping sounds had disappeared by the 2-year follow-up in 24 of the 25 patients. All patients who had presented with loss of flexion strength postoperatively showed recovery at postoperative week 6 to 10. Harris hip score improved from 65 points (range, 46 to 86 points) preoperatively to 84 points (range, 67 to 98 points) postoperatively (p < 0.001). Seven hips (28%) had an excellent score, 15 hips (60%) a good score, 2 hips (8%) a fair score, and one hip (4%) a poor score (p < 0.001). The Tonnis grade of osteoarthritis did not change in any of the patients at the last follow-up.

Conclusions: Patients with painful internal snapping hip have combined hip pathologies. Therefore, the surgeon should keep in mind that painful internal snapping hips are frequently combined with concomitant intraarticular pathologies.

Keywords: Arthroscopy; Femoroacetabular impingement; Iliopsoas tendon tenotomy; Internal snapping hip syndrome.

Fig. 1. Intraoperative photographs of a 31-year-old woman who was diagnosed with labral tear and internal snapping hip show intact iliopsoas tendon (A) and released iliopsoas tendon (B).

Fig. 2. Fluoroscopic image of the arthroscope and an electrocautery in position inside the iliopsoas bursa around head and neck junction.