The surgical treatment of internal snapping hip

BACKGROUND: Internal snapping hip is an underdiagnosed cause of hip pain that sidelines many recreational and competitive athletes. It originates from a taut iliopsoas tendon that snaps across bony prominences when the hip is extended from a flexed position. When nonoperative treatment methods fail, fractional tendon-lengthening procedures may be used. HYPOTHESIS: Surgical tendon lengthening through a true ilioinguinal approach, which has not been previously reported, will achieve good results in patients with internal snapping hip. STUDY DESIGN: Retrospective cohort study. METHODS: In 30 patients with symptoms in their anterior hip, internal snapping hip was diagnosed by history and physical examination. All patients were initially treated nonoperatively; 19 (63%) improved and did not require further intervention. Eleven patients (12 hips) whose symptoms were recalcitrant to physical therapy were offered the surgical option of iliopsoas tendon lengthening. The procedure was performed via an ilioinguinal intrapelvic approach. Patients were followed up for an average of 3 years. RESULTS: All 11 surgically treated patients (100%) had complete postoperative mitigation of their snapping hip. Nine (82%) reported excellent pain relief. Moreover, nine patients thought that they had greatly benefited from the tendon lengthening and would repeat the surgery. CONCLUSION: Although nonoperative measures are usually successful in the treatment of internal snapping hip, surgical tendon lengthening is a viable approach in cases refractory to nonoperative therapy.     

局部浸润麻醉下弹响髋关节镜辅助手术的疗效分析

23例(25髋)弹响髋分别在局部浸润麻醉(21髋)与椎管内麻醉(14髋)下关节镜辅助手术治疗,前者较后者手术疗效更为理想,平均手术时间更短;两者平均功能恢复时间无显著性差异,均无严重并发症发生.局部浸润麻醉下关节镜辅助手术治疗弹响髋疗效肯定.     

Ischiofemoral impingement of the hip: a novel approach to treatment

Ischiofemoral impingement (IFI) is an uncommon source of hip pain recently described in the non-surgical hip, associated with decreased space between the lesser trochanter and the ischium. There are no reports in the English literature of surgical treatment of this problem. We describe a case of IFI in a 19-year-old female who failed conservative management and underwent endoscopic surgical intervention to increase the space between her ischium and proximal femur. More than 2 years later, the patient is doing very well with an improvement of her iHOT score of 53 points to 85. Level of evidence IV.     

Surgical indications for treatment for femoroacetabular impingement with surgical hip dislocation

Purpose

There is a lack of detailed information about the indications of surgical treatment for femoroacetabular impingement (FAI), particularly using open surgical dislocation. The purpose of this review was to systematically review the reported indications for surgical dislocation of the hip for FAI.

Methods

Two databases (MEDLINE and EMBASE) were screened for clinical studies involving the treatment for FAI with surgical hip dislocation. We conducted a full-text review and the references for each included paper were hand-searched for other eligible studies. Papers published until September 2011 were included in this review. Two individuals reviewed all identified studies independently, and any disagreement was resolved through consensus.

Results

Fifteen studies met the eligibility criteria, which included a total of 822 patients. We identified a lack of consensus for clinical and radiographic indications for surgical hip dislocation to treat FAI. The most common clinical indications reported were clinical symptoms such as hip pain in 10 papers (67 %), a positive impingement sign in 9 papers (60 %), painful/reduced range of motion in 9 papers (60 %), activity-related groin pain in 4 papers (27 %), and non-responsive to non-operative treatment in 4 papers (27 %). The most commonly reported radiographic indicators for surgical hip dislocation were a variety of impingement findings from radiographs in all 15 included papers (100 %), a combination of radiographs and MRA in 5 papers (33 %) or radiographs and MRI in 3 papers (20 %).

Conclusions

These results showed that that there was an inconsistency between the clinical and radiographic indications for surgical hip dislocation as a treatment for femoroacetabular impingement. This review suggests that there is a need for the development of standardized clinical and radiological criteria that serve as guidelines for surgical treatment for FAI.

Level of evidence

Systematic review, Level IV.     

Arthroscopic treatment of the painful "internal" snapping hip: results of a new endoscopic technique and imaging protocol

BACKGROUND: Traditional surgical treatment for a painful snapping iliopsoas tendon has been an open lengthening of the tendon. HYPOTHESIS: An endoscopic release will alleviate painful snapping of the tendon. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Six patients with painful snapping hips who had no pain relief after magnetic resonance arthrography, which included injection of bupivacaine into the hip joint, subsequently had an ultrasound evaluation of their iliopsoas tendons and an anesthetic injection into the psoas bursa. In all 6 patients, the injection relieved their hip pain, and in 4, real-time imaging demonstrated snapping of the tendon. All hips were evaluated with the 100-point Harris hip scoring system before and at 1.5, 3, 6, and 12 months after surgery. RESULTS: Preoperative hip scores averaged 58 points. After surgery, all patients had hip flexor weakness, used crutches for 5 weeks, and had 6-week scores that averaged 62 points. The patients continued to improve, and at 6 and 12 months, their scores averaged 90 and 96 points, respectively, and none had recurrence of their snapping or pain. CONCLUSION: Ultrasound-guided anesthetic injection of the psoas bursa is useful to confirm snapping of the iliopsoas tendon as the cause of a patient's hip pain. Endoscopic release of the tendon is a safe outpatient procedure that provides effective relief of the snapping and pain.     

The surgical treatment of external coxa saltans (the snapping hip) by Z-plasty of the iliotibial band

PURPOSE: A snapping hip (coxa saltans) secondary to a tight iliotibial band rarely needs surgical intervention. The purpose of this study is to present the surgical results of refractory external-type snapping hip by Z-plasty of the iliotibial band. MATERIALS AND METHODS: Nine symptomatic snapping hips in 8 consecutive patients (1 bilateral) from August 1997 through March 2002 who underwent an iliotibial band Z-plasty were reviewed. RESULTS: Eight of the 9 hips were in active-duty military and 1 was a civilian, with an average age of 25.6 years (range, 21 to 38 years). Mean duration of symptoms prior to surgical intervention was 25.2 months (range, 16 to 39 months) with an average follow-up of 22.9 months (range, 7 to 38 months). All patients had complete resolution of the snapping hip, and all but 1 returned to full unrestricted activities. The 1 failure had persistent groin pain but no residual snapping. CONCLUSIONS: Patients with snapping hip of the iliotibial band refractory to conservative treatment are rare. The surgical results of Z-plasty are excellent and predictable. Careful screening is necessary to preclude other confounding diagnoses. Z-plasty is recommended as an effective surgical treatment of the refractory snapping hip secondary to iliotibial band tightness.     

Case report: hepatic and splenic calcification due to amyloid

A case of marked hepatic and splenic calcification due to primary amyloidosis is presented. Although the patient had been treated with continuous ambulatory peritoneal dialysis, there was no evidence of a causal relationship with the calcification. Amyloid is known to have an affinity for calcium, but this radiographic manifestation has not been previously reported.     

Femoroacetabular impingement: a common cause of hip pain

Femoroacetabular impingement (FAI) is a common cause of hip pain that can affect a wide range of patients. It is due to altered bony morphology of the proximal femur and acetabulum, resulting in decreased function and progression to early osteoarthritis. Until the early 2000s, little was known or understood about the significance of FAI as a clinical entity. The field of hip preservation has grown exponentially since that time, and has led to many advances in caring for those with symptomatic impingement. This review details the early diagnosis and proper management of femoroacetabular impingement for the sports medicine practitioner.     

Case report: hypoglycemia and diffusion-weighted imaging

The effect of severe hypoglycemia on the brain is well known, ranging from alterations of mental status to profound coma and death. We describe a case of global diffusion abnormalities eventually resulting in death. This otherwise healthy patient presented with seizures and a serum glucose level less than 20 mg/dL. Testing suggested that the hypoglycemia was likely caused by exogenous insulin or perhaps insulin receptor antibodies. Magnetic resonance imaging on the day after admission showed regions of restricted diffusion in the temporal and occipital lobes as well as in the basal ganglia. Despite the large body of literature concerning the pathophysiology of hypoglycemia and its clinical implications, little is known regarding its radiologic correlations.     

MR imaging of pituitary hypertrophy due to juvenile primary hypothyroidism: a case report

We present a case of pituitary hypertrophy due to juvenile primary hypothyroidism with subsequent return to normal size after therapy. This clinical entity is well known, but there are few reports on its magnetic resonance (MR) findings. We stress the usefulness of Gadolinium-DTPA-enhanced (Gd-DTPA-enhanced) MRI in the differential diagnosis of pituitary hypertrophy and pituitary adenoma.     

Magnetic resonance imaging of the hip at 3 Tesla: clinical value in femoroacetabular impingement of the hip and current concepts

Magnetic resonance imaging (MRI) is the most promising noninvasive modality for hip joint evaluation, but it has limitations in diagnosing cartilage lesion and acetabular labrum changes, especially in early stages. This is significant due to superior outcome results of surgery intervention in hip dysplasia or femoroacetabular impingement in patients not exceeding early degeneration. This emphasizes the need for accurate and reproducible methods in evaluating cartilage structure. In this article, we discuss the impact of the most recent technological advance in MRI, namely the advantage of 3-T imaging, on diagnostic imaging of the hip. Limitations of standard imaging techniques are shown with emphasis on femoroacetabular impingement. Clinical imaging examples and biochemical techniques are presented that need to be further evaluated.     

Case report: MR appearance of a retained surgical sponge.

A case of a retained surgical sponge found in the retroperitoneum is presented with findings on magnetic resonance (MR) imaging, computed tomography (CT), ultrasonography (US) and angiography. Among all the performed modalities, a characteristic internal structure of the gauze granuloma was best visualized on MR imaging. If no radio-opaque marker is seen on plain radiography or CT, the folded fabric inner structure visualized on T2-weighted images can be a most important clue to the correct diagnosis of this iatrogenic mass.