From the Guidelines
Surgical treatment for internal snapping hip syndrome should be considered after conservative measures have failed, with arthroscopic release of the iliopsoas tendon being the preferred approach, as it is less invasive and results in faster recovery times 1.
Key Considerations
- The primary goal of surgical treatment is to relieve tension on the iliopsoas tendon, which is the main structure causing the snapping sensation.
- Arthroscopic techniques are generally preferred over open procedures due to their minimally invasive nature, resulting in smaller incisions, less pain, and faster recovery times.
- The procedure involves partial release or lengthening of the iliopsoas tendon where it passes over the iliopectineal eminence or femoral head.
Recovery and Outcomes
- Recovery typically involves physical therapy for 6-12 weeks, with a gradual return to activities.
- Patients usually use crutches for 1-2 weeks and focus on gentle range of motion exercises, progressing to strengthening exercises and sport-specific training.
- Surgery is effective in approximately 80-90% of cases, with potential complications including temporary weakness in hip flexion, persistent pain, or recurrence of symptoms 1.
Diagnostic Evaluation
- MRI is highly sensitive and specific for detecting soft tissue abnormalities, including those related to internal snapping hip syndrome, and should be used as the primary imaging modality after radiographs 1.
- Ultrasound can also be used to evaluate snapping hip syndrome and localize fluid collections for aspiration and injection 1.
From the Research
Surgical Treatment Options
- Endoscopic release of the iliopsoas tendon is a viable treatment option for internal snapping hip syndrome, with studies showing significant improvement in symptoms and function 2, 3, 4.
- Open surgical techniques, such as fractional tendon-lengthening procedures, can also be effective in treating internal snapping hip syndrome, especially in cases where nonoperative treatment has failed 5.
- Endoscopic transcapsular release of the iliopsoas tendon has been shown to be a safe and effective procedure, with good outcomes and low recurrence rates 4.
Outcomes and Complications
- Studies have reported significant improvement in hip function and reduction in pain after surgical treatment, with most patients experiencing complete resolution of snapping symptoms 2, 5, 3, 4.
- However, patients may experience loss of flexion strength after iliopsoas tenotomy, which can be a significant complication 2, 6.
- The presence of multiple iliopsoas tendons can also affect treatment outcomes, and incomplete release of the tendon can lead to refractory pain and poor results 4, 6.
Comparison of Treatment Options
- Endoscopic release of the iliopsoas tendon has been shown to have better outcomes and fewer complications compared to open techniques 6.
- The treatment of concomitant intra-articular pathologies during endoscopic surgery may also contribute to better outcomes 6.
- However, more research is needed to fully compare the efficacy and safety of different surgical treatment options for internal snapping hip syndrome.