Endoscopic Treatment of External Coxa Saltans (Snapping Hip) in the Supine Position

Abstract

External coxa saltans, or "snapping hip," is present in about 5% of the population and typically stems from a tight iliotibial band (ITB) passing over the greater trochanter. For patients who have been unresponsive to nonoperative treatments, endoscopic ITB release can be effective in relieving symptoms. Various techniques have been described, including those involving lateral decubitus positioning, alternative portal placement, and outside-in release of the ITB. In this technique, we describe an endoscopic partial ITB release for external coxa saltans using supine positioning, standard hip arthroscopy portals, and inside-out release from the peritrochanteric space, which allows treatment of concomitant intra-articular pathology and direct visualization of the posterior undersurface of the ITB for a more precise release of the involved pathologic tissue.

Fig 1

(A) Layout of operating room with patient positioned supine on traction table for a left hip procedure. (B) Schematic of operating room layout for left hip procedure (1: surgeon, 2: assist, 3: surgical tech).

Fig 2

In a left hip, the patient is positioned supine with the 70° arthroscope placed through the midanterior portal, and the arthroscopic shaver is placed through the anterolateral portal for resection of the trochanteric bursa and visualization of the undersurface of the iliotibial band and surrounding structures.

Fig 3

In a left hip, the patient is positioned supine with the 70° arthroscope placed through the midanterior portal. (A) Resection of the bursa over the vastus ridge. (B) Visualization of the gluteus maximus tendon insertion on the proximal femur. (C) Visualization of the vastus lateralis following bursal resection.

Fig 4

In a left hip, the patient is positioned supine with the 70° arthroscope placed through the midanterior portal. Endoscopic view shows anteroposterior release of the posterior thickening of the undersurface of the ITB using a radiofrequency ablation wand. This portion of the ITB is commonly the offending area that snaps over the greater trochanter. (ITB, iliotibial band.)

Fig 5

In a left hip, the patient is positioned supine with the 70° arthroscope placed through the midanterior portal. (A) Endoscopic view shows the extension of the ITB release distally through the thickened posterior tissue. (B) Endoscopic view shows the extension of the ITB release proximally through the thickened posterior tissue. (C) Endoscopic view shows the resultant diamond-shaped defect after debridement of the triangular flaps from the cruciate release. (ITB, iliotibial band.)