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The Surgical Treatment of Internal Snapping Hip

Gary S. Gruen, MD^*,, Thomas N. Scioscia, MD^* and Jason E. Lowenstein, MD

^* Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
Department of Orthopaedic Surgery, New York Orthopaedic Hospital, Columbia-Presbyterian Medical Center, New York, New York

Address correspondence and reprint requests to Gary S. Gruen, MD, Department of Orthopaedic Surgery, 3471 Fifth Avenue, Suite 1010, Pittsburgh, PA 15213

Background: Internal snapping hip is an underdiagnosed cause of hip pain that sidelines many recreational and competitive athletes. It originates from a taut iliopsoas tendon that snaps across bony prominences when the hip is extended from a flexed position. When nonoperative treatment methods fail, fractional tendon-lengthening procedures may be used.

Hypothesis: Surgical tendon lengthening through a true ilioinguinal approach, which has not been previously reported, will achieve good results in patients with internal snapping hip.

Study Design: Retrospective cohort study.

Methods: In 30 patients with symptoms in their anterior hip, internal snapping hip was diagnosed by history and physical examination. All patients were initially treated nonoperatively; 19 (63%) improved and did not require further intervention. Eleven patients (12 hips) whose symptoms were recalcitrant to physical therapy were offered the surgical option of iliopsoas tendon lengthening. The procedure was performed via an ilioinguinal intrapelvic approach. Patients were followed up for an average of 3 years.

Results: All 11 surgically treated patients (100%) had complete postoperative mitigation of their snapping hip. Nine (82%) reported excellent pain relief. Moreover, nine patients thought that they had greatly benefited from the tendon lengthening and would repeat the surgery.

Conclusion: Although nonoperative measures are usually successful in the treatment of internal snapping hip, surgical tendon lengthening is a viable approach in cases refractory to nonoperative therapy.

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