Purpose
To assess the effects of surgery for lesser trochanteric–ischial impingement (LTI)
on low back pain.
Methods
The records of patients with LTI who underwent endoscopic partial resection of the
lesser trochanter (LT) between May of 2017 and February of 2019 were reviewed. Inclusion
criteria were the presence of low back pain in association with hip pain, diagnosis
of LTI, and partial resection of the LT to treat LTI. Exclusion criteria were less
than 12 months of postoperative follow-up and hip or spine surgery after the LTI surgery.
Patients were assessed before surgery and at the most recent follow-up with the modified
Harris Hip Score and Oswestry Disability Index for lumbar spine.
Results
Thirty patients (31 hips) met the inclusion criteria. Four patients were lost to follow-up.
Two patients with borderline dysplasia and grade 1 and 2 osteoarthritis underwent
total hip arthroplasty after the partial resection of the LT. The results are presented
considering the remaining 24 patients (25 hips). The average age at surgery was 51
years (range 32-65 years). The mean follow-up after the surgery for LTI was 19 months
(range 12-35 months). The mean ± SD ODI improved from 48% ± 15 before the LTI surgery
to 21% ± 22 (P < .001) at the most recent follow-up. Improvement in the Oswestry Disability Index
above the minimal clinical important difference was observed in 16 patients (67%)
following the LTI surgery. The mean ± SD modified Harris Hip Score improved from 55.8
± 14 before LTI surgery to 81.3 ± 14.3 (P < .001).
Conclusions
Decrease in low back pain above the minimal clinically important difference is observed
in 2 of 3 patients after partial resection of the LT.
Level of Evidence
Level IV, therapeutic case series.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to ArthroscopyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Epidemiology of chronic low back pain in US adults: Data from the 2009–2010 National Health and Nutrition Examination Survey.Arthritis Care Res. 2016; 68: 1688-1694
- Expenditures and health status among adults with back and neck problems.JAMA. 2008; 299: 656
- Hip-spine syndrome.Spine (Phila Pa 1976). 1983; 8: 316-321
- The Hip-spine effect: A biomechanical study of ischiofemoral impingement effect on lumbar facet joints.Arthroscopy. 2017; 33: 101-107
- The influence of spine-hip relations on total hip replacement: A systematic review.Orthop Traumatol Surg Res. 2017; 103: 559-568
- Measuring extension of the lumbar–pelvic–femoral complex with the EOS® system.Eur J Orthop Surg Traumatol. 2015; 25: 1061-1068
- Correlations of hip mobility with degree of back pain and lumbar spinal mobility in chronic low-back pain patients.Spine (Phila Pa 1976). 1988; 13: 668-670
- Patterns of hip rotation range of motion: A comparison between healthy subjects and patients with low back pain.Phys Ther. 1990; 70: 537-541
- Unilateral hip rotation range of motion asymmetry in patients with sacroiliac joint regional pain.Spine (Phila Pa 1976). 1998; 23: 1009-1015
- Low back pain in professional golfers: Tthe role of associated hip and low back range-of-motion deficits.Am J Sports Med. 2004; 32: 494-497
- Back pain and total hip arthroplasty: A prospective natural history study.Clin Orthop Relat Res. 2010; 468: 1325-1330
- Factors associated with early improvement in low back pain after total hip arthroplasty: A multi-center prospective cohort analyses.J Arthroplasty. 2016; 31: 176-179
- Spinopelvic parameter changes and low back pain improvement due to femoral neck anteversion in patients with severe unilateral primary hip osteoarthritis undergoing total hip replacement.Eur Spine J. 2018; 27: 125-134
- The effect of total hip arthroplasty on sagittal spinal–pelvic–leg alignment and low back pain in patients with severe hip osteoarthritis.Eur Spine J. 2016; 25: 3608-3614
- Effect of knee and hip position on hip extension range of motion in individuals with and without low back pain.J Orthop Sport Phys Ther. 2000; 30: 307-316
- The prone hip extension test: A method of measuring hip flexion deformity.Clin Orthop Relat Res. 1977; 123: 12-15
- Valgus hip with high antetorsion causes pain through posterior extraarticular FAI.Clin Orthop Relat Res. 2013; 471: 3774-3780
- Hip morphology predicts posterior hip impingement in a cadaveric model.HIP Int. 2019; 29: 322-327
- Impingement of the lesser trochanter on the ischial ramus after total hip arthroplasty. Report of three cases.J Bone Joint Surg Am. 1977; 59: 268-269
- Diagnosis and 2-year outcomes of endoscopic treatment for ischiofemoral impingement.Arthroscopy. 2015; 31: 239-246
- Ischiofemoral impingement syndrome: An entity with hip pain and abnormalities of the quadratus femoris muscle.AJR Am J Roentgenol. 2009; 193: 186-190
- Ischiofemoral impingement: A retrospective analysis of cases in a specialist orthopaedic centre over a four-year period.Hip Int. 2013; 23: 263-268
- The Oswestry Disability Index.Spine (Phila Pa 1976). 2000; 25: 2940-2953
- Prospective analysis of hip arthroscopy with 2-year follow-up.Arthroscopy. 2000; 16: 578-587
- Accuracy of 2 clinical tests for ischiofemoral impingement in patients with posterior hip pain and endoscopically confirmed diagnosis.Arthroscopy. 2016; 32: 1279-1284
- A systematic approach to the plain radiographic evaluation of the young adult hip.J Bone Joint Surg Am. 2008; 90: 47-66
- Anteversion of the acetabulum and femoral neck in normals and in patients with osteoarthritis of the hip.Acta Orthop Scand. 1983; 54: 18-23
- The slump test: Examination and treatment.Aust J Physiother. 1985; 31: 215-219
- Magnetic resonance classification of lumbar intervertebral disc degeneration.Spine (Phila Pa 1976). 2001; 26: 1873-1878
- Interpretation of changes in health-related quality of life.Med Care. 2003; 41: 582-592
- Determining the clinical importance of treatment benefits for interventions for painful orthopedic conditions.J Orthop Surg Res. 2015; 10
- Clinical outcomes after arthroscopic psoas lengthening: The effect of femoral version.Arthroscopy. 2012; 28: 965-971
- Prevalence of chronic low back pain: Systematic review.Rev Saude Publica. 2015; 49
- In vivo measurements of the ischiofemoral space in recreationally active participants during dynamic activities: A high-speed dual fluoroscopy study.Am J Sports Med. 2017; 45: 2901-2910
- Dynamic ischiofemoral impingement: Case-based evidence of progressive pathophysiology from hip abductor insufficiency: A report of two cases.JBJS Case Connect. 2018; 8: e107
- The effect of dynamic femoroacetabular impingement on pubic symphysis motion: A cadaveric study.Am J Sports Med. 2012; 40: 1113-1118
Article info
Publication history
Published online: January 15, 2021
Accepted:
January 3,
2021
Received:
August 6,
2020
Footnotes
See commentary on page 1510
The authors report the following potential conflicts of interest or sources of funding: H.D.M. reports personal fees from Smith & Nephew, outside the submitted work. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
Funding: This study was funded by the Baylor Scott and White Research Institute.
Identification
Copyright
© 2021 by the Arthroscopy Association of North America
