Arthroscopy of the Hip, The Snapping Hip: Surgical Management Pearls

The arthroscopic management of the snapping hip can be accomplished with minimal morbidity and successful, reproducible results. Typical internal and external snapping hip are treated by relative lengthening of the tendinous portion of the iliopsoas or the iliotibial band, respectively. The evidence- based literature is sparse, and this reflects the rarity of patient cases that necessitate operative intervention. However, clinical experience offers guidance. Select patients who have symptomatic snapping that has failed an adequate trial of good nonoperative management, that includes stretching and strengthening of the affected tendon. Tailor the surgical approach to the patient. For internal snapping, options include (1) at the level of the lesser trochanter (may be ideal for hip arthroplasty patients); (2) peripheral compartment; and (3) central compartment. Generally, the senior author prefers inspection of the central compartment to address any concomitant intra- articular pathology, followed by peripheral compartment iliopsoas tendon lengthening. The results of this approach are superior to open approaches in addressing internal snapping hip. External snapping approaches include (1) subcutaneous excision of the center of the iliotibial band; and (2) peritrochanteric approach where just the posterior third of the iliotibial band can be addressed directly and selectively; both have equivalent results and appear equivalent with open approaches. Recognize other factors that may influence surgical success such as accurate lengthening; and for internal snapping, associated impingement, labral and/or chondral pathology, heterotopic ossification, femoral anteversion, capsuloligamentous laxity, prior hip arthroplasty; for external snapping, trochanteric bursitis, gluteal tendinopathy and tears, as well as voluntary snappers.