Summary

Primary hip arthroscopy addressing femoroacetabular impingement and painful external snapping hip syndrome with ITB and gluteus maximus tendon release demonstrated significant improvement in all evaluated patient-reported outcomes.

Abstract

Purpose

This study aimed to report midterm outcomes of hip arthroscopy that concomitantly treats femoroacetabular impingement (FAI) and external snapping hip syndrome (ESH), with a comparison to a benchmark control group.

Methods

Data was retrospectively analyzed for hips who underwent hip arthroscopy and iliotibial band and gluteus maximus tendon release as treatment for FAI and ESH between 2008 and 2019. Included patients had complete pre- and postoperative patient reported outcomes (PROs) or a documented endpoint at minimum five-year follow-up. Rates of revision surgery and conversion to total hip arthroplasty (THA) were included in the analysis. Patients were propensity matched to a benchmark control group of FAI patients without ESH in a 1:4 ratio by sex, age at surgery, body mass index (BMI), Acetabular Outerbridge Grade, labral treatment, and capsular treatment.

Results

A total of 215 hips (211 patients) were included in the study. The study group showed significant improvements in all assessed PROs, with 98% of patients reporting resolution of painful external snapping at latest follow up, and no patients requiring revision hip arthroscopy secondary to persisted external snapping. When compared to the benchmark control group, patients with ESH had similar preoperative scores, magnitudes of improvement, and postoperative scores for mHHS, NAHS, HOS-SSS and VAS. Furthermore, MCID and PASS for all evaluated PROs were met at similar rates.

Conclusions

Primary hip arthroscopy addressing FAI and painful ESH with ITB and gluteus maximus tendon release demonstrated significant improvement in all evaluated PROs, with 98% of patients reporting resolution of external snapping, and no revision surgery due external snapping recurrence at minimum five-year follow-up. Functional outcomes and rates of clinically relevant thresholds achievement were comparable to a propensity-matched benchmark control group without ESH.