External snapping hip: a new technique for ultrasound-assisted sectioning of the iliotibial band

BACKGROUND: External snapping hip (ESH) is the most typical form of coxa saltans and is caused by the iliotibial band (ITB) slipping over the greater trochanter (GT) during a hip movement. In combination with a typical interview and specific clinical tests, dynamic ultrasound imaging appears to be an important tool to confirm the diagnosis and precisely identify the cause of slipping. Surgical treatment is indicated in some cases of symptomatic ESH that are refractory to well-managed conservative treatment, in selected patients. Many procedures have been described, from open surgery to endoscopy. The purpose of this study was to (1) describe and (2) compare a new technique for ultrasound-assisted sectioning of the iliotibial band with a similar endoscopic technique, in terms of sectioning rates, iatrogenic injuries, learning curve and material cost. METHODS: An anatomic study was conducted. After a feasibility study to describe the technique, 6 specimens were available, i.e. 12 hips. Both procedures were carried out on each specimen followed by an open control procedure to take measurements. A junior surgeon carried out all the procedures. RESULTS: The average sectioning rate of the ITB was 92% in the ultrasound group, compared to 90% in the endoscopy group. No iatrogenic injuries were noted, including nerve damage. The average duration of the ultrasound procedure was 15 minutes compared to 24.7 minutes for endoscopy, with a decrease by a factor of 2 to 3 between the first and last procedure, regardless of the technique. Incomplete sectioning rates were noted at the beginning of the study and all reached 100% by the 4th procedure, regardless of the technique. The ultrasound procedure was 1.8 times less expensive in terms of equipment than the endoscopic procedure, and up to 3 times less expensive in terms of consumables alone (119.56 euros vs 353.48 euros). CONCLUSION: This technique of ultrasound-assisted sectioning of the ITB seems to be as effective and safe as a similar endoscopic technique, with an attainable learning curve for surgeons in training, for an average period and with lower material costs.