Ultrasound-guided surgery for lateral snapping hip: a novel ultraminimally invasive surgical technique

BACKGROUND: Greater trochanteric pain syndrome encompasses a range of causes of lateral hip pain including greater trochanteric bursitis, tendinopathy and tears of the gluteus minimus and medius, and lateral snapping hip (LSH). Surgical options for LSH range from open surgery to endoscopic surgery, including a diamond-shaped cut or a simple transversal release to gluteus maximus tendon release. Resection of an area of proximal iliotibial band (ITB) and step-cut or z-plasty lengthening have not proven superior to transverse release of the ITB. Therefore, making a complete and effective transverse cut guided by ultrasound may represent a potential advance over endoscopic surgery. PURPOSE: In this case series study, we describe how to perform proximal release of the ITB guided by ultrasound. METHODS: The surgical technique—either z-plasty or transverse section of the ITB—was first validated on 10 cadaver specimens and then used in clinical practice. Fourteen patients (5 males and 9 females) were operated from 2014 to 2018. Mean age was 43 years (29–62). RESULTS: The snap resolved in all patients, as verified actively during the surgical procedure as the patient has only local anesthesia. The VAS score for sports activity improved from 7 (5–9) before surgery to 0 (0–2) after 1 year. The HSS score improved from 58 points (47–72) to 96 at 1–2 years. There were no complications other than minor hematomas nor recurrences. CONCLUSION: Ultrasound-guided release of the LSH is a novel surgical option with encouraging results in patients for whom conservative protocols have failed. It can be performed under local anesthesia in an outpatient setting with minimal aggressiveness. It is relatively easy, quick, and painless; no stitches are required. Weight bearing is immediate, and patients usually need crutches for only 2–3 days. Although complete recovery may take 3 months, the rehabilitation protocol is fast and painless.