Snapping Hip Syndrome: Systematic Review of Surgical Treatment

Abstract

The snapping hip (SH) syndrome is characterised by an audible snapping, often accompanied by pain, which usually occurs with the flexion and extension of the hip during exercise or ordinary daily activities.The causes of SH can be classified as external, internal and intraarticular. The prevalence of asymptomatic SH in the population is unknown and the incidence of symptomatic cases is not well-defined. The painless snapping in the hip is common in the general population; the symptomatic SH with debilitating pain and weakness is often seen in those who take part in activities such as ballet and running hurdles.The clinician's goal is to determine the cause and treat patients who have symptomatic SH so that they may return to their activities or to athletic peak performance.Most patients with SH can be treated conservatively. However, surgery may be indicated if the condition becomes chronically symptomatic. Arthroscopy may prove useful in the treatment of intraarticular lesions that are causing discomfort. Various techniques have been described with different grades of success. The aim is to achieve the least invasive procedure with the lowest potential complications that corrects the painful snapping, according to the patient's characteristics.The purpose of this systematic review is to clarify the results of the surgical treatment of SH, after the failure of the conservative treatment.

Imagenological findings of external snapping hip syndrome. Case report

“…Possible surgical procedures include resection of the major trochanteric bursa, trochanter osteotomy and, in refractory cases, arthroscopic release of the ITB or lengthening of the ITB by Z-plasty. (1,2) The failure of surgery in the reported case is still cause for study. Specialists believe that the recurrence of symptoms may be associated to a marked fibrotic process following the two surgical procedures; however, that baseline hyperlaxity may be associated with recurrence of symptoms is considered a possibility.…”

“…There is still no consensus to determine diagnostic parameters. (2,11) Dynamic ultrasound shows thickening of the iliotibial band and heterogeneous echogenicity of the fibers, as well as secondary findings such as distension of the greater trochanteric bursa. This dynamic evaluation is useful since it verifies movement of the ITB or the tendon of the gluteus maximus on the greater trochanter, and allows perceiving the dislocation or listening to the "snap", thus leading to the definitive diagnosis of this syndrome.…”

“…This dynamic evaluation is useful since it verifies movement of the ITB or the tendon of the gluteus maximus on the greater trochanter, and allows perceiving the dislocation or listening to the "snap", thus leading to the definitive diagnosis of this syndrome. (2,4) The appropriate tool to perform the dynamic ultrasound evaluation is a high frequency linear transducer (12 MHz or higher), with the patient in supine or standing position. Based on the radiologist's preference, the transducer is placed transversely to the greater trochanter, and the exploration is performed with active and passive flexion and external rotation maneuvers of the hip.…”

“…(2) At present, three types are described: internal, external (included by some authors in extra-articular) (1,2,4) and intra-articular. The first is caused by the IBT sliding over the femoral head or acetabular ridge, the second by the IBT sliding over the greater trochanter (2), and the third by different causes, mainly degenerative, such as labrum tears, damage to the liagementum teres or loose bodies in the hip. (1,2,4).…”

An approach to hip pain in a young adult

“…A snapping or clunking sensation and occasionally an audible noise can be generated by certain tendons moving over bony prominences around the hip (either of the iliotibial band over the greater trochanter or the iliopsoas tendon over the anterior hip structures) 27. Patients can often reproduce the symptom on demand.…”