Abstract
PurposeThe aim of this retrospective study was to investigate the clinical follow-up of patients with external snapping hip syndrome (ESHS) treated with endoscopic gluteus maximus tendon release and to compare the residual muscular strength and thigh circumference as an indirect outcome measure.MethodsPatients of all ages with external snapping hip syndrome were treated with endoscopic gluteus maximus tendon release. Outcome measures evaluated included: visual analog scale (VAS), modified Harris Hip Score (mHHS), and Non-Arthritic Hip Score (NAHS). The gluteus maximus strength and the circumference of the thigh were also evaluated.ResultsAmong 25 patients, 23 fulfilled the inclusion criteria and one patient was lost to follow-up. The series included 22 patients, 6 males and 16 females with a mean age of 27.9 ± 13.4 years (range 16–76 years). All patients had resolution of the snapping symptoms after the procedure. The mean follow-up was 18 ± 9.3 months. All outcomes improved in a statistically significant manner: VAS value decreased from 6.8 (range 6–8) to 0.6 (range 0–4) (p < 0.001), mHHS increased from 48.6 (range 17.6–67) to 88.2 (range 67–94.6) (p < 0.001), NAHS increased from 49.0 (range 21.5–66) to 90.8 (range 66–98.75) (p < 0.001). A statistically significant reduction of operated limb thigh circumference compared to the contralateral side (3.7%) was also found, while there were no statistical differences regarding the strength of gluteus maximus muscles.ConclusionsEndoscopic gluteus maximus tendon release is an excellent surgical option to treat snapping hip syndrome. The evaluated muscle strength revealed no functional impairment. The significance of the limb circumference reduction has yet to be determined.Level of evidenceIV: retrospective comparative trial.
Highlights
The snapping hip (SH), or coxa saltans, is a common clinical condition that may occur in up to 10% of the general population [1]
Materials and methods External snapping hip syndrome was diagnosed with clinical examination: the snap was identified by palpation of the trochanteric region with flexion–extension of the hip, and by asking the patient to reproduce it voluntarily
Postoperative modified Harris Hip Score (mHHS) increased to 88.2 ± 8.6 points (p value < 0.001)
Summary
The snapping hip (SH), or coxa saltans, is a common clinical condition that may occur in up to 10% of the general population [1]. The first treatment approach is conservative with rest, restriction of painful positions or activities, soft tissue massage, stretching exercises, non-steroidal anti-inflammatory drugs [6,7,8] and, in few cases, steroid injections into the area of maximal tenderness (trochanteric) [1, 9, 10]. Polesello et al have described an alternative endoscopic technique to avoid the possible iatrogenic deformity of the lateral thigh sometimes described with the previous techniques. This technique is based on the anatomical and functional correlation between the GM muscle and the ITB. The GM femoral insertion is endoscopically released close to the linea aspera, decreasing the tension of the ITB over the greater trochanter [5]
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