Original Article With Video Illustration
Diagnosis and 2-Year Outcomes of Endoscopic Treatment for Ischiofemoral Impingement

https://doi.org/10.1016/j.arthro.2014.07.031Get rights and content

Purpose

The purposes of this study were to investigate the clinical and radiographic presentation of patients with ischiofemoral impingement (IFI) and to assess the outcomes of endoscopic treatment with partial resection of the lesser trochanter.

Methods

Five patients with IFI who underwent endoscopic treatment with partial resection of the lesser trochanter were retrospectively reviewed. The outcomes were assessed at a mean follow-up of 2.3 years (range, 2 to 2.5 years) through the modified Harris Hip Score and a visual analog scale score for pain. Physical examination tests provoking the impingement between the lesser trochanter and ischium were used for the diagnosis of IFI, including the IFI test and reproducible pain lateral to the ischium with the long-stride walking test. The presence of quadratus femoris muscle edema and a decreased ischiofemoral space on magnetic resonance imaging was also necessary for the diagnosis.

Results

The mean modified Harris Hip Score increased from 51.3 points (range, 34.1 to 73.7 points) preoperatively to 94.2 points (range, 78.1 to 100 points) at the final follow-up (P = .003). The mean visual analog scale score for pain decreased from 6.6 (range, 6 to 7.3) before surgery to 1 (range, 0 to 4) at the final follow-up (P = .001). The mean duration to return to sport after surgery was 4.4 months (range, 1 to 7 months) for the 5 patients in this study. No complication was observed.

Conclusions

The endoscopic treatment of IFI was effective at 2 years in 5 patients with consistent clinical and imaging diagnostic findings.

Level of Evidence

Level IV, therapeutic case series.

Section snippets

Methods

The reports of 144 patients who consecutively underwent hip arthroscopic and endoscopic procedures between August 2011 and January 2012 were retrospectively reviewed. The inclusion criteria were patients who had a diagnosis of IFI and who underwent endoscopic partial resection of the lesser trochanter. The exclusion criteria were patients with isolated intra-articular pathology or less than 2 years of follow-up. Five patients (5 hips) met the inclusion criteria, and no patient was excluded.

Results

All 5 patients complained of deep gluteal pain and limitation when performing physical activities before surgery. The mean duration of symptoms until surgery was 29.2 months (range, 5 to 66 months) (Table 1). All patients had undergone consultations with 4 or more orthopaedic surgeons before the diagnosis, although no history of surgery of the hip was present in any patient. The mean ischiofemoral space was 8.9 mm (range, 2.3 to 13.2 mm) and the mean quadratus femoris space was 6.1 mm (range,

Discussion

The endoscopic treatment of IFI successfully improved the functional scores in all 5 patients in this study at a minimum follow-up of 2 years. There are only a few published studies of surgical treatment for correction of IFI.1, 6, 7, 8, 9 Johnson1 was the first author to describe lesser trochanter resection through an open approach. In 2 patients IFI was due to total hip arthroplasty. The third patient presented with impingement after a proximal femoral osteotomy, and lesser trochanter

Conclusions

The endoscopic treatment of IFI was effective at 2 years in 5 patients with consistent clinical and imaging diagnostic findings.

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The authors report the following potential conflict of interest or source of funding: H.D.M. receives support from Smith & Nephew and owns stock in Pivot Medical.

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