Clinical outcome following a modified approach for psoas lengthening for coxa saltans in adults

Abstract

Internal snapping often resolves with conservative treatment but persistent significant symptoms may require surgical treatment. Different surgical approaches have been suggested in the literature with varying results. We describe a modified surgical approach for internal snapping of hip in adults with good results. Patients who failed conservative treatment for internal snapping over 11/2 years were included. A skin crease incision was made just lateral to the ASIS in supine position. The psoas tendon was reached sub-periosteally along the internal iliac surface and a hole was made in periosteum. Then the tendon was hooked into the wound and divided releasing its musculotendinous junction. The patients were allowed to mobilise as able in the postoperative period. There were 8 snapping hips (7 patients, 6 females) with average age of 30 years (17-51 yrs). The mean follow-up was 11 months. The average duration of symptoms before operation was 4.5 years (range 2-10 years). Painful symptomatic clicking was relieved in all patients. Two patients felt slight weakness of hip flexion. One patient had temporary neuropraxia of lateral cutaneous nerve of thigh. The diagnosis is made by ultrasound or examination for a palpable click. Surgical correction of snapping is considered after failure of conservative treatment. Different extrapelvic (medial and iliofemoral) and intrapelvic extraperitoneal approaches have been described with varying results. With our slightly modified intrapelvic and subperiosteal approach through oblique inguinal incision in adults, psoas muscle release at musculotendinous junction seems a safe and effective method and could be used as an alternative surgical approach for treatment of internal snapping of hip in adults.

Iliopsoas Release: A Systematic Review of Clinical Efficacy and Associated Complications

“…This systematic review identified 3 surgical indications for iliopsoas release: (1) internal snapping hip (n = 28; 58.3%), 5–7,17,19–42 (2) labral tear secondary to iliopsoas impingement (n = 4; 8.3%), 8,43–45 and (3) iliopsoas tendinopathy after THA (n = 15; 31.3%). 10,13–16,46–55 One case report (n = 1; 2.1%) 56 documenting hip dislocations after hip arthroscopy, iliopsoas release was performed, but initial surgical indications were for CAM impingement with no mention of internal snapping hip or iliopsoas impingement.…”

Snapping Hip Syndrome: Systematic Review of Surgical Treatment

“…10 articles were about the treatment of ESH with a total of 145 patients treated with 3 different techniques (2 with open approach and 1 with arthroscopic) (37–46). 11 articles were about ISH with a total of 243 patients who underwent the same technique (with open or arthroscopic approach) (47–57).…”

“…Komarasamy et al 2007 (53), described a modified open surgical approach for ISH of 8 hips in 7 patients. The skin was incised just lateral to the antero-superior iliac spine in supine position.…”

“…The systematic review shows that the surgical treatment of ISH ensures good results in terms of medium and long-term efficacy: the success ranges from 62.5% to 100% and the failure ranges from 0% to 37.5% (recurrent snapping without pain 2-25%, recurrent snapping with pain 4-16%) (47–59). The open approach ensures a success ranging from 62.5% to 100% with a failure ranging from 0% to 37.5%, as reported in the available studies (47–52).…”

“…The arthroscopic approach is described by 7 studies showing a success ranging from 82% to 100% (53–59), with a failure ranging from 0% to 18% (recurrent snapping without pain 2%, recurrent snapping with pain 4%-16%), as reported by 3 studies (56–58).…”