Pain relief and good functional outcomes after hip endoscopy via posterior approach in patients with ischiofemoral impin
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Pain relief and good functional outcomes after hip endoscopy via posterior approach in patients with ischiofemoral impingement Bernardo Aguilera‑Bohórquez1 · Mario Leiva1,2 · Julio Pacheco1,2 · Daniela Calvache1 · Miguel Fernandez1,2 · Erika Cantor3 Received: 9 April 2020 / Accepted: 28 September 2020 © European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2020
Abstract Purpose Ischiofemoral impingement is considered to be an uncommon and difficult pathology to diagnose with respect to hip pain etiology. The objective was to describe the clinical results of endoscopic lesser trochanter resection via a posterior approach in patients with Ischiofemoral impingement. Methods This was a retrospective observational study of consecutive patients with Ischiofemoral impingement, who underwent endoscopic resection of the lesser trochanter via a posterior approach, between 2015 and 2018. Clinical results were evaluated using the ischiofemoral impingement test, long-stride walking test, modified Harris Hip Score (mHHS) and the Oxford scale to assess the strength of the iliopsoas muscle as well as the presence of complications. Preoperative and postoperative ischiofemoral space was measured to assess whether the resection of the lesser trochanter was adequate. Results 16 hips in 13 patients (mean age: 34.4 ± 12.1 years, 11 women) with a follow-up period between 24 and 59 months were included. Preoperative ischiofemoral space ranged from 6.4 to 22.4 mm, a measure > 17.0 mm was achieved in 15 hips without the presence of pain in IFI test and long-strides walking test. Function improved postoperatively, as reflected by a higher mean mHHS (preoperative: 44.6 ± 21.5, postoperative: 81.2 ± 15.1, p 17.0 mm, a magnetic resonance imaging (MRI) was performed to measure the quadratus femoris space (QFS), which was defined as the distance between the medial aspect of the iliopsoas tendon and the lateral aspect of the origin of the hamstring muscles (Fig. 1b). In these cases, a 3-dimensional (3D) dynamic study (Clinical Graphics®, Move Forward; Zimmer Biomet, Miami, FL) was performed to evidence the abnormal contact between the ischium and the lesser trochanter (Fig. 1c, d). Preoperative IFS was measured by two independent observers in CT with an inter-rater reliability of 0.944 (95% confidence interval 0.890–0.999) using the concordance correlation coefficient (CCC). Prior to surgery, all patients were initially treated with conservative management for a minimum period of three months that included activity modification, rest, walking with short strides, NSAIDs and physical therapy.
Surgical technique Endoscopic resection was performed with the patient in the supine decubitus position with the hip positioned in internal rotation and without the use of traction. The subgluteal space was accessed through the anterolateral and posterolateral portals with 30° lens. In addition, an accessory distal posterolateral portal was made to achieve better visualization of the lesser trochanter. First, the course of the s
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