What are the treatment options for coxa saltans (snapping hip syndrome)?

From the Guidelines

Treatment for snapping hip syndrome should prioritize conservative measures, including physical activity and physiotherapist-led treatment, to improve hip-related pain and function, as recommended by the international hip-related pain research network 1. The goal of treatment is to address both the mechanical issue and any resulting inflammation, with a focus on improving morbidity, mortality, and quality of life.

• Conservative measures should include rest, activity modification, and over-the-counter pain medications like ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily) for 1-2 weeks to reduce inflammation.
• Physical therapy is crucial, focusing on stretching tight structures (particularly the iliotibial band and hip flexors) and strengthening the hip abductors, core muscles, and rotators.
• Specific exercises include hip flexor stretches held for 30 seconds and repeated 3-5 times daily, and clamshell exercises with 10-15 repetitions for 2-3 sets daily.
• Applying ice to the affected area for 15-20 minutes several times daily can help reduce inflammation.
• If conservative treatments fail after 4-6 weeks, corticosteroid injections may be considered, as diagnostic and therapeutic injections are safe and useful tools for confirming the location of pain and, in some cases, helping in its control for a short period 2.
• In rare cases where symptoms persist despite comprehensive conservative management for 6 months or longer, surgical intervention might be necessary.
• Imaging studies, such as MRI, may be used to evaluate the hip joint and surrounding soft tissues, but should be used judiciously and only when necessary, as recommended by the American College of Radiology 2.

From the Research

Treatment Options for Snapping Hip Syndrome

• Conservative measures are typically the first line of treatment, including anti-inflammatories, stretching, and avoidance of inciting activities 3, 4, 5
• Physical therapy and rest are also recommended for symptomatic cases 4, 5
• Arthroscopic procedures can be beneficial for recalcitrant cases, offering a non-invasive treatment option 4, 6
• Surgical interventions, such as endoscopic release of the ilio-tibial band or the femoral insertion of the gluteus maximus tendon, may be necessary for patients who do not respond to conservative management 6, 7

Surgical Techniques

• Endoscopic techniques are preferred over open surgery due to fewer complications, lower recurrence rates, and good clinical outcomes 6
• The "fan-like" technique is a stepwise, tailor-made solution for external snapping hip syndrome, allowing for gradual increase in the extent of surgery based on intraoperative observations 7
• Different surgical approaches are recommended for internal and external snapping hip syndrome 4

Outcomes and Complications

• Most cases of snapping hip syndrome resolve after 6-12 months of conservative management 4
• Complications from conservative treatments are rare, but may include weakness, infection, nerve damage, and atrophy following surgical procedures 5
• Symptomatic snapping hip syndrome can become asymptomatic following intervention, with advancements in treatment options leading to improved outcomes 4