Efficacy of Surgery for Internal Snapping Hip

Abstract

Our purpose was to evaluate evidence regarding the effectiveness of open iliopsoas release and lengthening with arthroscopic approaches, which combine iliopsoas release with the treatment of intra-articular pathology as treatments for internal snapping hip syndrome. Searches were performed of 4 databases and 12 reports on the surgical treatment of internal snapping hip were reviewed. The authors tabulated data according to year of study, journal, study type, level of evidence, patient demographics, procedure, and outcomes. We found that surgical treatment of internal snapping hip improves patient symptoms in the majority of patients. Endoscopic release is associated with fewer reported complications compared with open release. All studies of endoscopic treatment of internal snapping hip syndrome also performed intra-articular examination and treatment of intra-articular pathology. The incidence of associated intra-articular pathology was reported in 5 of 6 studies. These results suggest that a painful snapping iliopsoas tendon in many cases may be a result of intra-articular hip pathology rather than an independent entity. Early studies suggest no difference in efficacy or associated complications rate when comparing extracapsular to transcapsular iliopsoas tendon release. Further studies are needed comparing operative to nonoperative treatment and methods of determining patients likely to benefit from operative intervention.

Key words

snapping hip - internal snapping hip - coxa saltans

• References

• 1 Adler RS, Buly R, Ambrose R, Sculco T. Diagnostic and therapeutic use of sonography-guided iliopsoas peritendinous injections. Am J Roentgenol 2005; 185: 940-943
• 2 Allen WC, Cope R. Coxa Saltans: The snapping hip revisited. J Am Acad Orthop Surg 1995; 3: 303-308
• 3 Anderson SA, Keene JS. Results of arthroscopic iliopsoas tendon release in competitive and recreational athletes. Am J Sports Med 2008; 36: 2363-2371
• 4 Blankenbaker DG, De Smet AA, Keene JS. Sonography of the iliopsoas tendon and injection of the iliopsoas bursa for diagnosis and management of the painful snapping hip. Skeletal Radiol 2006; 35: 565-571
• 5 Byrd JW. Evaluation and management of the snapping iliopsoas tendon. Instr Course Lect 2006; 55: 347-355
• 6 Contreras ME, Dani WS, Endges WK, De Araujo LC, Berral FJ. Arthroscopic treatment of the snapping iliopsoas tendon through the central compartment of the hip: a pilot study. J Bone Joint Surg Br 2010; 92: 777-780
• 7 Deslandes M, Guillin R, Cardinal E, Hobden R, Bureau NJ. The snapping iliopsoas tendon: new mechanisms using dynamic sonography. Am J Roentgenol 2008; 190: 576-581
• 8 Dobbs MB, Gordon JE, Luhmann SJ, Szymanski DA, Schoenecker PL. Surgical correction of the snapping iliopsoas tendon in adolescents. J Bone Joint Surg Am 2002; 84-A: 420-424
• 9 Flanum ME, Keene JS, Blankenbaker DG, Desmet AA. Arthroscopic treatment of the painful “internal” snapping hip: results of a new endoscopic technique and imaging protocol. Am J Sports Med 2007; 35: 770-779
• 10 Gruen GS, Scioscia TN, Lowenstein JE. The surgical treatment of internal snapping hip. Am J Sports Med 2002; 30: 607-613
• 11 Guillin R, Cardinal E, Bureau NJ. Sonographic anatomy and dynamic study of the normal iliopsoas musculotendinous junction. Eur Radiol 2009; 19: 995-1001
• 12 Hoskins JS, Burd TA, Allen WC. Surgical correction of internal coxa saltans: a 20-year consecutive study. Am J Sports Med 2004; 32: 998-1001
• 13 Ilizaliturri Jr VM, Chaidez C, Villegas P, Briseno A, Camacho-Galindo J. Prospective randomized study of 2 different techniques for endoscopic iliopsoas tendon release in the treatment of internal snapping hip syndrome. Arthroscopy 2009; 25: 159-163
• 14 Ilizaliturri Jr VM, Villalobos Jr FE, Chaidez PA, Valero FS, Aguilera JM. Internal snapping hip syndrome: treatment by endoscopic release of the iliopsoas tendon. Arthroscopy 2005; 21: 1375-1380
• 15 Jacobson T, Allen WC. Surgical correction of the snapping iliopsoas tendon. Am J Sports Med 1990; 18: 470-474
• 16 Janzen DL, Partridge E, Logan PM, Connell DG, Duncan CP. The snapping hip: clinical and imaging findings in transient subluxation of the iliopsoas tendon. Can Assoc Radiol J 1996; 47: 202-208
• 17 Komarasamy B, Vadivelu R, Kershaw CJ. Clinical outcome following a modified approach for psoas lengthening for coxa saltans in adults. Hip Int 2007; 17: 150-154
• 18 Nunziata A, Blumenfeld I. Snapping hip; note on a variety. Prensa Med Argent 1951; 38: 1997-2001
• 19 Pelsser V, Cardinal E, Hobden R, Aubin B, Lafortune M. Extraarticular snapping hip: sonographic findings. Am J Roentgenol 2001; 176: 67-73
• 20 Taylor GR, Clarke NM. Surgical release of the ‘snapping iliopsoas tendon’. J Bone Joint Surg Br 1995; 77: 881-883
• 21 Vaccaro JP, Sauser DD, Beals RK. Iliopsoas bursa imaging: efficacy in depicting abnormal iliopsoas tendon motion in patients with internal snapping hip syndrome. Radiology 1995; 197: 853-856
• 22 Wettstein M, Jung J, Dienst M. Arthroscopic psoas tenotomy. Arthroscopy 2006; 22: 907.e.1-907.e.4
• 23 Winston P, Awan R, Cassidy JD, Bleakney RK. Clinical examination and ultrasound of self-reported snapping hip syndrome in elite ballet dancers. Am J Sports Med 2007; 35: 118-126