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Arthroscopic Labral Hip Repair and Lesser Trochanter Excision for Management of Ischiofemoral Impingement

March 01, 2019

Contributors: Dylan Lowe, MD; Thomas Youm, MD; Anna Katsman, MD; Anna Katsman, MD

Ischiofemoral impingement (IFI) is a rare source of hip pain caused by narrowing between the lateral aspect of the ischial tuberosity and the lesser trochanter of the femur. Reduction of the intervening space leads to entrapment of the quadratus femoris muscle and may cause pain in the lower buttock, groin, and medial thigh. IFI was first described in 1977 in patients who underwent total hip arthroplasty and femoral osteotomy. Since then, IFI has been described in the native hips of adults and children and is associated with a variety of pathologies. Nonsurgical management consisting of physical therapy and NSAIDs is the preferred initial treatment option; however, surgical treatment is successful in patients in whom nonsurgical treatment fails. Recently, an arthroscopic approach has emerged as a reliable and successful method to expose the lesser trochanter for resection. However, careful technique is necessary to attain consistent results and avoid complications. This video demonstrates arthroscopic lesser trochanteric resection for management of IFI. This video provides an overview of the anatomy, pathogenesis, and management of IFI. The video discusses the case presentation of a 58-year-old woman with IFI and femoroacetabular impingement. Complete resection of the lesser trochanter was achieved intraoperatively. The patient successfully completed a postoperative rehabilitation protocol and experienced resolution of her symptoms. Arthroscopic lesser trochanter excision is a safe and reliable treatment option for patients with IFI in whom nonsurgical treatment fails.