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Background While many authors have recommended surgery for patients with persistent symptoms of external snapping hip, it is unclear which one best relieves symptoms. Concerns with iliotibial band (ITB)-modifying techniques include altering the shape of the lateral thigh and overload of the contralateral abduction mechanism. We describe a new endoscopic technique that decreases the tension of the ITB complex by releasing the femoral insertion of the gluteus maximus tendon (GMT). Description of Technique Via an endoscopic approach, we tenotomize the GMT near its insertion at the linea aspera through two trochanteric portals, developing a space beneath the ITB. Methods We reviewed eight patients (nine hips) with external snapping hip nonresponsive to nonoperative treatment treated by endoscopic GMT release. There were seven women (one bilateral) and one man, with a mean ± SD age of 35 ± 13.1 years (range, 18-55 years). Mean symptom duration was 36 ± 20.3 months (range, 16-84 months). Minimum followup was 22 months (mean, 32 ± 9.3 months; range, 22-45 months). Results Snapping and pain resolved in seven patients after the initial procedure. We performed one revision procedure with complete relief of symptoms. All eight patients returned to their previous level of activity. Average modified Harris hip score was 61 points (range, 45-70 points) preoperatively and 78 points (range, 62-93 points) at latest followup. We observed no neurovascular complications. Conclusions Our small series suggests endoscopic release of the GMT resolves pain and snapping symptoms in most patients. Level of Evidence Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

OBJETIVO: O Harris Hip Score é instrumento de avaliação específica, desenvolvido originalmente para avaliar os resultados da artroplastia total de quadril. O objetivo deste estudo foi traduzir e adaptar culturalmente este instrumento para a língua portuguesa. MÉTODO: O método de tradução e adaptação cultural do Harris Hip Score envolveu quatro etapas: 1 - tradução inicial; 2 - retrotradução; 3 - apreciação das versões com elaboração da versão de consenso; 4 - pré-teste comentado com elaboração da versão final. RESULTADOS: A versão de consenso foi aplicada em 30 pacientes com afecção do quadril, sendo verificadas dificuldades no entendimento de algumas expressões, as quais foram substituídas por termos de mais fácil entendimento. Na reaplicação do questionário com a nova versão houve entendimento por 100% dos pacientes no que diz respeito ao sentido semântico, idiomático e contextual. CONCLUSÃO: A versão brasileira do Harris Hip Score permitiu a disponibilização de mais este instrumento para avaliação da qualidade de vida de pacientes com afecções do quadril. Há necessidade de um estudo de avaliação da confiabilidade e validade da versão adaptada culturalmente, a qual já está em desenvolvimento.

ObjectiveThis was an epidemiological study on fractures of the proximal third of the femur in elderly patients who were treated at a teaching hospital in the central region of São Paulo.MethodsThe subjects were patients over the age of 60 years who were attended over a 1-year period. A questionnaire seeking basic sociodemographic data and information on comorbidities presented and medications used was drawn up. The circumstances of the fractures and their characteristics, the treatment instituted and the intra-hospital mortality rate were evaluated.ResultsThe 113 patients included in the study presented a mean age of 79 years. The ratio between the sexes was three women to each man. Only 30.4% of the patients reported having osteoporosis and only 0.9% had had treatment for the disease. Low-energy trauma was the cause of 92.9% of the fractures. Femoral neck fractures accounted for 42.5% of the fractures and trochanteric fractures, 57.5%. Five patients did not undergo operations; 39 underwent joint replacement; and 69 underwent osteosynthesis. The mean length of hospital stay was 13.5 days and the mean length of waiting time until surgery was 7 days. The intra-hospital mortality rate was 7.1%.ConclusionThe patients attended at this institution presented an epidemiological profile similar to what is found in the Brazilian literature. Chronic kidney failure is a significant factor with regard to intra-hospital mortality. Preventive measures such as early diagnosis and treatment of osteoporosis and regular physical activity practices were not implemented.

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Objective: To compare the efficacy of platelet rich plasma (PRP) against corticosteroid on the treatment of trochanteric pain syndrome. Methods:From July 2011 to November 2012, eighteen patients (20 hips) with trochanter pain syndrome were randomized in two groups and treated with platelet rich plasma or triamcinolone infiltration guided by ultrasound. Pain and function were evaluated prior to the intervention and after 10, 30 and 60 days, through the Facial Expressions Scale for Pain and the Western Ontario McMaster and Harris Hip Score questionnaires. Inter-group analysis was performed by Student t-test and intragroup analysis by ANOVA, followed by Bonferroni post hoc test. Statistical significance was set at p <0.05. Results:There was no difference between the groups. The triamcinolone group showed pain reduction (p=0.004) and improved function (p=0.036) through the Harris Hip Score questionnaire at 10, 30 and 60 days after treatment, when compared with the pre- intervention period. The platelet rich plasma group showed no statistical improvement in any of the variables. Conclusion: Up to 60 days, PRP infiltration has no influence on pain relief and function improvement in trochanteric syndrome treatment. Level of Evidence II, Prospective Comparative Study.

Objective: Hip arthroscopy has been used for diagnostic as well as therapeutic purposes, and it is part of the daily arsenal of hip surgeons. Due to the need for arthroscopic evaluation of the results, Byrd proposed a modification of the Harris Hip Score by assessing pain and function. This study aimed to translate and cross-culturally adapt the evaluation protocol of the modified Harris Hip Score used in hip arthroscopies. Method: The method used consisted of: 1) an initial translation, 2) a back translation, 3) a pre-test and 4) a final test. Results: The Portuguese version was used with 30 patients with hip disorders to determine the level of comprehension of the protocol. Expressions which were not understood by patients during the pre-test were modified or replaced, and the final version was obtained by consensus. The final version of the questionnaire was used once again, with 100% understanding by patients. Conclusion: Thus we arrived at the final Portuguese version of the modified Harris Hip Score questionnaire. Verification of the validity of this version is already in progress.

Diagnoses of hip and pelvis disorders are based on the detailed medical history, physical examination and laboratory tests, as appropriate for each condition. Plain radiography is still the initial examination of choice and, because of its importance, there is a need to standardize radiographic studies, both in relation to execution and in radiographic series, according to the different pathological conditions. The aim of this paper was to propose standardization for the main radiographic views of the hip and pelvis, and with regard to performing specific series for different pathological conditions, and to provide technical guidance for achieving these aims.