Abstract
PurposeThere has been relatively little information about the treatment for ischiofemoral impingement (IFI) because of its rarity as well as the uncertainty of diagnosis. The aim of this study was to provide the reader with the available treatment strategies and their related outcomes for IFI based on the best available evidence, whilst highlighting classically accepted ways of treatment as well as relatively new surgical and non-surgical techniques.MethodsA systematic review of the literature from Medline, Embase, AMED, Cochrane and Google Scholar was undertaken since inception to December 2017 following the PRISMA guidelines. Clinical outcome studies, prospective/retrospective case series and case reports that described the treatment outcome for IFI were included. Animal or cadaveric studies, trial protocols, diagnostic studies without any description of treatments, technical notes without any results, and review articles were excluded.ResultsThis systematic review found 17 relevant papers. No comparative studies were included in the final records for qualitative assessment, which means all the studies were case series and case reports. Eight studies (47.1%) utilised non-surgical treatment including injection and prolotherapy, followed by endoscopic surgery (5 studies, 29.4%) then open surgery (4 studies, 23.5%). Mean age of the participants was 41 years (11–72 years). The mean follow-up was 8.4 months distributed from 2 weeks to 2.3 years. No complications or adverse effects were found from the systematic review.ConclusionSeveral treatment strategies have been reported for IFI, and most of them have good short- to medium-term outcomes with a low rate of complications. However, there are no comparative studies to assess the superiority of one technique over another, thus further research with randomised controlled trials is required in this arena. This study explores the wide variety and categories of different treatments used for IFI to guide physicians and shed light on what can be done for this challenging cohort of patients.Level of evidenceIII.
Highlights
Ischiofemoral impingement (IFI) is an uncommon cause of pain and snapping in the hip, buttock, and groin
This study reviews all the cases of treatment for IFI (42 cases) with their results reported in the English literature and describes the outcomes of several techniques, which are divided into three categories: nonsurgical treatment, open surgical treatment, and endoscopic surgical treatment
The basic pathology of IFI is that ischiofemoral space is reduced and this leads to compression of the quadratus femoris (QF) muscle within the space causing pain
Summary
Ischiofemoral impingement (IFI) is an uncommon cause of pain and snapping in the hip, buttock, and groin. IFI was first described by Johnson in 1977 in three patients who had undergone an osteotomy of the hip or a hip replacement previously [18]. Despite it being described almost 40 years ago, it is still frequently misdiagnosed or neglected because of its rarity, and the absence of specific clinical findings and diagnostic tests [14, 26]. Several studies on the radiological features of IFI and distance between the ischium and the LT, i.e. ischiofemoral distance‚ have been published [14, 20, 31]. We have recently reported on the normal ischiofemoral distance (measured as the smallest distance between the lateral cortex of ischial tuberosity and the medial cortex of the LT) and its
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