Endoscopic Resection for Iliopectineal Bursitis Associated With Developmental Dysplasia of the Hip

Abstract

Iliopectineal bursitis usually develops subsequent to other hip pathologies and can often be treated conservatively. However, when conservative treatment fails or the enlarged bursa causes pain or compression of the surrounding neurovascular structures, surgery may be required. Most previous studies have described open surgeries, and reports on endoscopy are very limited. We present a case of iliopectineal bursitis associated with developmental dysplasia of the hip (DDH) that was successfully treated endoscopically. A 16-year-old female with a one-year history of right inguinal pain was referred to our department. She was diagnosed with a hip ganglion and treated with needle aspiration nine times by her previous doctor. Radiographs revealed bilateral DDH without narrowing of the joint space. Magnetic resonance imaging revealed a distinct mass in the deep layer of the iliopsoas muscle, and communication between the mass and the hip joint was observed on ultrasonography. Endoscopic debridement and resection were performed based on the diagnosis of iliopectineal bursitis. We partially debrided the medial side of the rectus femoris muscle toward the deep layer and resected the bursa. We observed a burst of concentrated content from the bursa and confirmed the disappearance of the mass by intraoperative ultrasonography. The postoperative course was good, and there were no functional restrictions or symptom recurrence at two-year postoperatively. Endoscopic resection for repetitive iliopectineal bursitis without an intraarticular procedure does not induce hip instability in patients with DDH and is a minimally invasive cosmetic procedure, and superior to open surgery, especially in young women.

Keywords: developmental dysplasia of the hip; extra-articular pathology of the hip; hip arthroscopy; hip endoscopy; iliopectineal bursitis.

Figure 1. Radiograph, anteroposterior view, shows no findings of osteoarthritis.

LCEA: lateral center-edge angles

Figure 2. Radiograph, false profile view, shows bilateral acetabular dysplasia of the hip.

VCA: vertical center anterior

Figure 3. Preoperative MRI, axial view, shows the high-intensity mass between the iliopsoas muscle and anterior capsule.

Figure 4. Preoperative ultrasonography image shows the hypoechoic mass anterior to the femoral head (asterisk) and its communication with the intraarticular space (arrow).

Figure 5. Intraoperative photograph of the intraarticular space shows minimally flayed labrum.

Figure 6. Intraoperative photograph of the extraarticular space shows the bursa is burst by debriding the space between the rectus femoris and the iliopsoas muscles (asterisk).

Figure 7. Two-year postoperative follow-up ultrasonography shows the mass in front of the hip joint is disappeared.