Snapping Hip Research Articles

Research progress on clinical diagnosis and treatment for external snapping hip

External snapping hip(ESH) is a vague term used to describe palpable or auditory snapping with hip movements with or without pain. The pathogenesis of ESH is related to the specific anatomical structure and friction factor. The clinical symptom is auditory snapping during activities, physical examination, X-ray, magnetic resonance imaging(MRI), dynamic ultrasound and other imaging techniques can be used to diagnose. Conservative medical management includes rest, avoidance of aggravating activities, and antiinflammatory medications. Treatment Patients with mild symptoms can achieve good results by medication, rest and physiotherapy. Surgical treatment for patients with ineffective conservative treatment was performed. All kinds of open surgery method can achieve good clinical curative effect, arthroscopic surgery is gradually been promoted due to small trauma, less complications. Besides, there are some reports that traditional treatments such as massage, acupuncture and acupotomology have achieved good clinical results, which deserve further study and promotion.

Coexistence of Femoroacetabular Impingement and Snapping Hip Due to Osteochondroma of the Femoral Neck - a Case Report

Introduction and objectives: The aim of this report is to highlight the uncommon association of femoroacetabular impingement and snapping hip due to an osteochondroma of the femoral neck. Case report: a 41 years old male patient complaining progressive pain, limited range of motion and snapping hip with audible click for more than five years was diagnosed with an association of different conditions affecting his right hip joint and surgical treatment was indicated with good outcome in one year follow-up. Conclusion: The authors pointed out the rare association of these conditions in the same joint and the need of correct interpretation of radiological and clinical findings for diagnosis, surgical planning and satisfactory resolution of symptomatology, leading to recovery of the individual’s functional capability.

US Assessment of Sports-related Hip Injuries.

Traumatic and overuse hip injuries occur frequently in amateur and professional athletes. After clinical assessment, imaging plays an important role in diagnosis and in defining care management of these injuries. Ultrasonography (US) is being increasingly used in assessment of hip injuries because of the wide availability of US machines, the lower cost, and the unique real-time imaging capability, which allows both static and dynamic evaluation as well as guidance of point-of-care interventions such as fluid aspiration and steroid injection. Accurate diagnosis of hip injuries is often challenging, given the complex soft-tissue anatomy of the hip and the wide spectrum of injuries that can occur. To conduct a skillful US evaluation of hip injuries, physicians must have pertinent knowledge of the normal anatomy and should make judicious use of surface anatomy landmarks while using a compartmentalized diagnostic approach. In this article, common sports-related injuries of the anterior, lateral, and posterior hip compartments are discussed. This review includes assessment of joint effusion, acetabular labral tear, acute and chronic tendon injuries including tendinopathy, partial and full-thickness tears, snapping hip syndromes, relevant US-guided procedures, and some other conditions such as Morel-Lavallée lesion and perineal nodular induration. Principles of care management and current knowledge on imaging findings that may affect return to activity are also presented. Using an oriented US examination technique and having knowledge of the normal hip anatomy will help physicians characterize US findings of common sports-related hip injuries and make accurate diagnoses. Online supplemental material is available for this article. ©RSNA, 2018.

Arthroskopische Behandlung des Psoasimpingements

Tenotomy of the psoas tendon in symptomatic internal coxa saltans or psoas impingement should relieve pain. Indicated in conservative treatment-resistant internal coxa saltans and in psoas impingement. Contraindications are symptomatic psoas pathologies in hip dysplasia patients. Three different procedures exist with the arthroscopic technique, in which the psoas tenotomy can be performed at one of three different levels. These are the arthroscopic transcapsular, the endoscopic extra-articular, and the arthroscopic central techniques. Forearm crutches are recommended for approximately 2-4weeks as well as physiotherapy to strengthen the hip flexors. A literature-based comparison could reveal no difference between the extra-articular and transcapsular techniques. Particularly in the long term was no loss of strength evident. Various different authors describe the techniques as good, finding neither complications nor recurrence of internal snapping hip.

Clinical Outcomes and Bearing-Specific Complications Following Fourth-Generation Alumina Ceramic-on-Ceramic Total Hip Arthroplasty: A Single-Surgeon Series of 749 Hips at a Minimum of 5-Year Follow-Up

BackgroundThe purpose of this study is to evaluate the minimum 5-year outcomes and bearing-specific complications in a single surgeon series of fourth-generation alumina ceramic-on-ceramic total hip arthroplasties (THAs). MethodsWe retrospectively analyzed 667 patients (749 hips) who underwent primary THAs by a single surgeon using fourth-generation alumina ceramic bearings. There were 315 men and 352 women with a mean age of 54.2 years. The surgeon used cementless prostheses with an identical design and BIOLOX Delta ceramics in all hips, using a 36-mm head in 472 hips (63%) and a 32-mm head in 227. The mean follow-up duration was 6.5 years (range, 5 to 8 years). ResultsThe mean Harris hip score improved from 45.6 points preoperatively to 91.3 points at final follow-up. All but 1 acetabular cup and all femoral stems were well fixed. No radiographic evidence of osteolysis was identified at final follow-up. There were 2 (0.3%) ceramic liner fractures and no ceramic head fractures. A total of 48 hips (6.4%) exhibited audible noise (29 clickings and 19 squeakings), but no patient required revision. Other complications were 1 dislocation, 1 deep infection, 3 iliopsoas tendonitis, and 6 periprosthetic femoral fractures. Kaplan-Meier survivorship for revision for any reason was 98.6% (95% confidence interval, 97.7-99.5) at 6.5 years. ConclusionDelta ceramic-on-ceramic THAs had a high rate of survivorship without radiographic evidence of osteolysis at 6.5-year follow-up. However, we found 0.3% ceramic liner fractures and 6.4% audible noises associated with the use of Delta ceramics.

Síndrome da Anca de Ressalto

Snapping hip syndrome is a condition in which the predominant symptom is the snapping feelingaround the hip joint caused by a dynamic impingement between muscles or tendons and boneprominences. The etiology of the snapping hip types and consequently the therapeutic targets havebeen subjects of discussion and controversy along the years. A careful clinical history and physicalexamination is frequently enough for this disease diagnosis. Treatment is typically conservative,however when it is not successful surgical treatment is indicated, consisting on the snapping muscleor tendons lengthening. The authors review in this paper the current scientific literature about functionalanatomy, physiopathology, symptoms, diagnosis and treatment of snapping hip.

Strategies in revision hip arthroscopy

With the recent increase in the use of hip arthroscopy, revision hip arthroscopy has also become more prevalent. Managing patients with residual and/or recurrent symptoms following hip arthroscopy is diagnostically and technically challenging. It is important to be aware of the most common reasons for failure, such as bony under-resection, labral tear or re-tear, progression of degenerative joint disease, and missed concurrent disorders such as subspine impingement, snapping hip syndrome, and athletic pubalgia. It is also important to rule out extra-articular causes of hip pain, such as referred pain from the spine or trochanteric bursitis. Pre-operative planning is of paramount importance if revision surgery is being considered, and three-dimensional modalities [such as magnetic resonance imaging and computed tomography (CT) with 3D reconstruction] are often required. Appropriate patient selection, honest discussions about potential outcomes, and management of patient expectations are important before proceeding with revision surgery. Intra-operatively, there are specific techniques and assistive technologies (e.g., fluoroscopy, navigation) that can aid in achieving a successful revision. Specific techniques have been developed for use in revision settings, such as labral and/or capsular reconstruction/grafting, remplissage for bony under-resection, and chondral implantation.

Comparison of arthroscopic versus open surgery on external snapping hip caused by gluteal muscle contracture.

To compare the outcomes of contracture release by arthroscopic versus open surgical approach in patients with external snapping hip (ESH) caused by gluteal muscle contracture (GMC). Medical records of patients with ESH due to GMC who underwent open surgery (n = 44) or arthroscopic surgery (n = 48) between October 2008 and October 2014 were reviewed. Patients were followed up at 1, 3, 12, and 24 months postoperatively. Operation time, incision length, postoperative pain, postoperative complication rate, and recurrence rate were compared between the 2 groups. Hip adduction, and Harris Hip Scores (HHS) at 1 and 2 years postoperatively were compared between the groups and with preoperative data. Mean operation time did not differ between the 2 groups (p>0.05). The arthroscopic surgery group had smaller incisions (p<0.05), less postoperative pain (p<0.05), lower complication rates (p<0.05) than did the open surgery group. The recurrence rates were similar for the 2 groups (p>0.05). Hip adduction, and HHS 1 year and 2 years postoperatively were significantly better postoperatively than they had been preoperatively for both groups (all p<0.01), and were similar for the 2 groups (all p>0.05). Arthroscopic release of contracture tissue is a safe and effective approach for the treatment of ESH caused by GMC, with the advantages of small scars, less postoperative pain, fewer complications compared with open surgery.

Endoscopic Treatment of Iliopsoas Tendinitis after Hip Resurfacing

Endoscopic Treatment of Iliopsoas Tendinitis after Hip Resurfacing

Iliopsoas Tendonitis following Total Hip Arthroplasty: Management of Nine Cases and Literature Review

Orthopedic Research Online Journal Iliopsoas Tendonitis following Total Hip Arthroplasty: Management of Nine Cases and Literature Review K Narayanasetty* Department of Locum Consultant in Orthopaedics, University Hospitals of Leicester NHS Trust, UK *Corresponding author: K Narayanasetty, Locum Consultant in Orthopaedics; R Power, Consultant in Orthopaedics, University Hospitals of Leicester NHS Trust, Leicester, UK Submission: August 08, 2017; Published: September 06, 2017 DOI: 10.31031/OPROJ.2017.01.000504 ISSN : 2576-8875Volume1 Issue1

External Snapping Hip Treated by Effective Designed N-plasty of the Iliotibial Band.

PurposeThe purpose of this study is to present the effective design of N-plasty of the iliotibial band and surgical results of its use as a treatment for refractory external snapping hip.Materials and MethodsWe evaluated 17 patients (24 cases) with external snapping hip who underwent N-plasty between October 2013 and May 2016 and who were followed up for at least 12 months. All patients were male and the mean age was 20.8 years. The mean duration of symptoms prior to surgical intervention was 28.5 months with an average follow up of 24.5 months. Surgery was defined as being successful when patients could carry out their daily activities and exercise without a clicking sensation or pain 6 months after surgery until their last follow-up. Failure was defined when either a clicking sensation or pain was present. The visual analog scale (VAS) and modified Harris hip score (mHHS) were measured and compared preoperatively and at last follow-up.ResultsAll patients had complete resolution of pain and snapping. The VAS decreased from 6.77 preoperatively to 0.09 postoperatively and mHHS improved from 69.5 to 97.8 after surgery.ConclusionModified designed N-plasty is considered to be an excellent treatment method facilitating operation reproducibility with maximum elongation effect of the iliotibial band.

Effectiveness of arthroscopy for synovial chondromatosis of hip joint

To evaluate the effectiveness of arthroscopy for synovial chondromatosis of hip joint. Between April 2012 and September 2015, 32 patients with synovial chondromatosis of hip joint were treated by arthroscopy. There were 19 males and 13 females, with an average age of 42.1 years (range, 22-64 years). The synovial chondromatosis located at right hip in 15 cases and left hip in 17 cases. The main clinical symptoms were pain and swelling of hip joint. Of all patients, 6 cases were hip hinge, 2 cases were lower limb weakness, and 1 case was snapping hip. The "4" sign was positive in 9 cases, Thomas' sign positive in 4 cases, and rolling test positive in 2 cases. All incisions healed by first intention, and no complication occurred. All patients were followed up 16-48 months (mean, 33.8 months). The visual analogue scale (VAS) was 1.4±0.8 at last follow-up, which was significantly lower than that before operation (4.8±1.2) ( t=6.382, P=0.013). The hip Harris score was 92.6±6.7 at last follow-up, which was significantly higher than that before operation (63.2±8.3) ( t=9.761, P=0.006). At last follow-up, the "4" sign and Thomas' sign were positive in 3 cases and 1 case, respectively. The others had no positive sign. X-ray film showed no recrudescence in all cases. Treating synovial chondromatosis of hip joint under arthroscopy has advantages of less trauma, complete debridement, quick postoperative recovery, and the satisfactory short-term effectiveness.

Analiza leczenia patologii stawu biodrowego metodą artroskopową

The study group consisted of 70 persons (surgeries of 72 hips). AVN - 14 patients, FAI - 38 patients (39 hips), HLT - 12 patients (13 hips), SHS - 6 patients. Two questionnaires, namely the MHHS (Modified Harris Hip Score) and NAHS (Non Arthritic Hip Score), were used to evaluate the patients before the surgery and at 6- and 12-month follow-up.[b]Results. [/b]AVN : local improvement was recorded at both 6 and 12 months, FAI: local improvement was recorded at both 6 and 12 months, HLT: local improvement was recorded at both 6 and 12 months, SHS: local improvement was recorded at both 6 and 12 months. Comparison of the results between the groups showed that: At baseline, local status in AVN was poorer than in FAI. At 6- and 12-month follow-up, local status in AVN was poorer than in FAI, HLT and SHS.[b]Conclusions.[/b] AVN Group 1. The study demonstrates that arthroscopic treatment of avascular necrosis produced fairly good outcomes at 6 and 12 months after the surgery. 2. Treatment of avascular necrosis showed significantly poorer results than therapy of femoroacetabular impingement, hip labral tear and snapping hip syndrome at 6 and 12 months. FAI Group 1. Arthroscopic treatment of femoroacetabular impingement produced good outcomes at 6 and 12 months after the surgery. HLT Group 1. Arthroscopic treatment of hip labral tear produced excellent outcomes at 6 and 12 months after the surgery. SHS Group 1. Arthroscopic treat ment of snapping hip syndrome produced excellent outcomes at 6 and 12 months after the surgery.Additional conclusions. 1. Studies showing long-term effect of arthroscopic treatment of selected conditions are necessary to further assess the effectiveness of this treatment. 2. It is necessary to evaluate the influence of the patients' age and severity of osteo arthritis on treatment outcomes in FAI. 3. It is necessary to assess the influence of the severity of pre-operative necrosis according to Ficat and Arlet classification on treatment outcomes in AVN.

The Dancers Hip: The Hyperflexible Athlete: Anatomy &amp; Arthroscopic Clinical Outcomes

Objectives:Competitive Dance places high demands on the hips joints and return to these activities after surgical management of intra-articular pathology is not well documented.Methods:Between 2008 and 2016, hip arthroscopy was performed for 63 competitive dancers (78 hips) with a mean age 21.0 years. Specific types of dance performed included 54 studio dance and 43 high kick dance. Morphology included Cam-type FAI (99%), Pincer-type FAI (45%), Subspine impingement (83%), Borderline dysplasia (9%), Dysplasia (10%), and Normal (5%). The mean preoperative LCE angle was 29.9 deg, alpha angle was 52.3 deg (Lateral), and offset ratio was 0.16. A positive Cross-over (COS) and Posterior Wall (PW) sign were present in 60% of hips, and the mean Tonnis angle was 3.2 deg. Outcomes were evaluated with MHHS, SF-12 scores, VAS scores.Results:At mean 19.7 months follow-up, the mean outcome improvements were 23.5 points (MHHS), 10.4 points (SF-12), 3.8 points (VAS), (p<.01 for each). MHHS improved from 60.5 points, preoperatively, to 84.0 points at most recent f/u (p<0.01). Sixty-seven percent returned to their prior level of competitive dance, 22% returned to limited or modified dance, and 10% were unable to return to dance, included 1 retirement. Procedures performed included 95% labral repairs, 10% labral debridements, 99% femoral resections, 55% rim resections, 83% subspine decompressions, and 68% capsular plications.Conclusion:Hip pain in dancers can be challenging secondary to high demands placed on the hips. A specific arthroscopic approach addressing subtle osseous abnormalities and capsular laxity led to significantly improved outcomes for competitive dancers. Eighty Nine percent of Dancers ultimately returned to competitive Dance, although only 67% returned to their pre-injury competitive level.

Clinical outcomes of arthroscopic surgery for external snapping hip

BackgroundStudies have reported on the arthroscopic technique for release of external snapping hip syndrome. However, no study with large sample size has been reported for arthroscopic surgery.MethodsPatients with 229 bilateral and 19 unilateral external snapping hips were treated from January 2012 to June 2013. After locating the contracture position, arthroscopic surgery was performed accordingly. Preoperative and postoperative angles were compared.ResultsComparing range of motion, all patients obtained higher adduction and flexion angles. At postoperative follow-up of 24 months, the adduction angle was improved from −14.4 ± 5.14 to 35.7 ± 4.21 for type I, from −31.2 ± 5.22 to 31.7 ± 2.84 for type II, from −49.0 ± 3.47 to 21.6 ± 3.43 for type III, and from −64.5 ± 4.65 to 18.3 ± 3.10 for type IV (P < 0.001). Similarly, the flexion angle was also significantly improved for all the four types (P < 0.001). Excellent ratio and satisfaction rate were good in types I and II. All the clinical features were cured after arthroscopic surgery.ConclusionsArthroscopic surgery could be an effective procedure for external snapping hip, due to less operating time, small scar, fast postoperative recovery, and complete contracture release.

Imaging of impingement syndromes around the hip joint.

Impingement syndromes are increasingly recognised as significant causes of hip pain and dysfunction. A broad spectrum of intraarticular and extraarticular conditions has been implicated in their pathophysiology. Physical examination is often inconclusive as clinical findings may be unclear or misleading, often simulating other disorders. With current improvements in imaging techniques and better understanding of hip impingement related pathomechanisms, these entities can be accurately diagnosed. In addition, preoperative imaging has allowed for targeted treatment planning. This article provides an overview of the various types of hip impingement, including femoroacetabular impingement, ischiofemoral impingement, snapping hip syndrome, greater trochanteric-pelvic and subspine impingement. Current literature data regarding their pathogenesis, clinical manifestation and imaging work-up are discussed.

Painful Hip Snapping In A 15 Year Old Female Soccer Player

HISTORY: A 15 y/o girl with history of bilateral iliotibial band (ITB) lengthening was referred to sports medicine clinic for diagnostic ultrasound of the right anterior hip due to painful snapping in the groin. Pain was exacerbated by kicking a ball. Sonographic examination demonstrated snapping iliacus and psoas major tendons with reproduction of groin pain. Physical therapy (PT) focusing on iliopsoas stretch was ineffective; she underwent iliopsoas tendon lengthening and synovectomy with complete resolution of pain. Five months following iliopsoas tendon lengthening, she returned with a new painful grinding sensation in the right buttock. Pain was exacerbated by walking, specifically at toe-off. Pain was sharp, episodic, and debilitating. She denied groin pain or pain with hip flexion. She denied neurologic deficits PHYSICAL EXAMINATION: Gen: No acute distress Neuro: Audible clunk with ambulation. Non-focal sensory, motor, and reflex examination of the RLE MSK: No visible defect of right buttock. Nontender over the gluteal region and ischial tuberosity. Pain reproduced with passive external hip rotation. Negative FABER, FAIR, log roll, Stinchfield, Ober, and scour DIFFERENTIAL DIAGNOSIS: 1. Ischiofemoral impingement 2. Hip labral/intraarticular pathology 3. Snapping gluteus maximus tendon/muscle 4. Recurrent iliotibial band snapping TEST AND RESULTS: MRI arthrogram: minimal labral fraying. Minimal symptom improvement with intraarticular steroid. Diagnostic ultrasound: hypertrophy of the right quadratus femoris (QF) (2.51cm right vs 1.54cm left) with dyskinetic motion of the QF between the ischial tuberosity and lesser trochanter during external hip rotation. Dyskinesis was more pronounced with standing and walking. Contralateral QF was void of dyskinetic movement. She underwent injection of lidocaine and triamcinolone into the right QF under sonographic guidance FINAL WORKING DIAGNOSIS: Ischiofemoral impingement 2/2 hypertrophied QF TREATMENT AND OUTCOMES: 1. Sonographically guided injection of lidocaine/corticosteroid resulted in diagnostic block from lidocaine component only 2. Discussed repeat injection vs debulking operation vs trial of botulinum toxin injection to the QF 3. Referred to PT for hip stretching and pelvic stabilization exercises

The iliotibial tract: imaging, anatomy, injuries, and other pathology.

The iliotibial tract, also known as Maissiat's band or the iliotibial band, and its associated muscles function to extend, abduct, and laterally rotate the hip, as well as aid in the stabilization of the knee. A select group of associated injuries and pathologies of the iliotibial tract are seen as sequela of repetitive stress and direct trauma. This article intends to educate the radiologist, orthopedist, and other clinicians about iliotibial tract anatomy and function and the clinical presentation, pathophysiology, and imaging findings of associated pathologies. Specifically, this article will review proximal iliotibial band syndrome, Morel-Lavallée lesions, external snapping hip syndrome, iliotibial band syndrome and bursitis, traumatic tears, iliotibial insertional tendinosis and peritendonitis, avulsion fractures at Gerdy's tubercle, and Segond fractures. The clinical management of these pathologies will also be discussed in brief.

Snapping hip syndrome: systematic review of surgical treatment.

The snapping hip (SH) syndrome is characterised by an audible snapping, often accompanied by pain, which usually occurs with the flexion and extension of the hip during exercise or ordinary daily activities.The causes of SH can be classified as external, internal and intraarticular. The prevalence of asymptomatic SH in the population is unknown and the incidence of symptomatic cases is not well-defined. The painless snapping in the hip is common in the general population; the symptomatic SH with debilitating pain and weakness is often seen in those who take part in activities such as ballet and running hurdles.The clinician's goal is to determine the cause and treat patients who have symptomatic SH so that they may return to their activities or to athletic peak performance.Most patients with SH can be treated conservatively. However, surgery may be indicated if the condition becomes chronically symptomatic. Arthroscopy may prove useful in the treatment of intraarticular lesions that are causing discomfort. Various techniques have been described with different grades of success. The aim is to achieve the least invasive procedure with the lowest potential complications that corrects the painful snapping, according to the patient's characteristics.The purpose of this systematic review is to clarify the results of the surgical treatment of SH, after the failure of the conservative treatment.

Postoperative imaging in arthroscopic hip surgery

Arthroscopic surgery of the hip, compared to that of the knee or the shoulder, has only recently been developed in any significant way. Current indications for arthroscopic surgery of the hip include: diagnosis and treatment of lesions symptomatic of the acetabular labrum, femoroacetabular impingement (FAI), chondral lesions, joint infections, lesions of the teres ligament, impingement of the psoas tendon, pathology of the peritrochanteric space, external snapping hip (coxa saltans), and traumatic and atraumatic instability. Principal indications for imaging of the hip with arthroscopic techniques are represented by persistent groin pain which may be caused by inadequate recognition or treatment of bone alteration of FAI, fractures in the site of resectioned bones, intra-articular adhesion, development of cartilaginous lesions, iatrogenic chondral lesions, recurrent lesions of the fibrocartilaginous acetabular labrum and heterotopic ossification. Postoperative checkup examinations can be undertaken with conventional radiography. The appearance or persistence of groin pain may be investigated using MRI, arthro-MRI and even CT scans.