Original article
Arthroscopic Surgery to Treat Intra-articular Type Snapping Hip

https://doi.org/10.1016/j.arthro.2005.05.021Get rights and content

Purpose: To reveal the causes of the intra-articular type snapping hip and their frequency. Type of Study: Case series. Methods: We studied 2 hip joints of 2 male patients and 30 hip joints of 28 female patients with snapping hip syndrome, in which the accompanying pain was transiently relieved by intra-articular injection of local anesthetic. The mean age at diagnosis was 26 years. Plain radiography, hip arthrography, magnetic resonance imaging (MRI), and arthroscopy were performed in these patients and the findings were compared. Results: Plain radiography findings showed no abnormality in 11 joints, hip osteoarthritis in 19 joints, and femoral head deformation caused by Perthes disease and synovial osteochondromatosis in 1 joint each. Excluding the case of synovial osteochondromatosis, 31 joints were examined by MRI, which failed to identify the cause of snapping hip in all cases. Hip arthrography revealed an intra-articular loose body in 2 joints with osteoarthritis. Arthroscopy revealed acetabular labral tears in all 11 joints with no abnormalities and 15 of 19 joints with osteoarthritis on plain radiography films, and incompatibility between acetabular labrum and deformed femoral head in 2 joints with osteoarthritis. In the case of femoral head deformation after Perthes disease, arthroscopy revealed detachment of the femoral head cartilage as a result of impingement of the acetabulum on the femoral head. Arthroscopic surgeries were conducted: partial limbectomy for acetabular labral tears, surgical removal of loose bodies, partial femoral head excision for incompatibility between acetabular labrum and deformed femoral head, and shaving or articular cartilage detachment. The surgeries resolved the snapping in all cases. Conclusions: Acetabular labral tear was the cause of 80% of cases of intra-articular type snapping hip. Incompatibility between the acetabular labrum and a deformed femoral head was found to be a cause of intra-articular type snapping hip. Level of Evidence: Level IV, case series.

Section snippets

Methods

The present study was a retrospective review of clinical cases. Between April 1995 and June 2003, the same author (Y.Y.) examined a total of 95 hip joints with snapping hip accompanied by pain, at the Department of Orthopedic Surgery, University of Yamanashi Faculty of Medicine and Ichikawadaimon Municipal Hospital. The criteria of snapping hip were (1) a patient could consistently reproduce snapping with active hip motion and (2) the examiner could confirm the clicking sound or palpate

Results

Plain radiographs showed no abnormality in 11 joints, osteoarthritis of the hip in 19 joints, femoral head deformation caused by Perthes disease in 1 joint, and synovial osteochondromatosis in 1 joint. MRI and arthrography were conducted in 31 joints (the joint with synovial osteochondromatosis was not imaged). MRI failed to show any findings that might be considered as the cause of snapping in all cases. Hip arthrography identified an intra-articular loose body in 2 joints with osteoarthritis.

Discussion

The causes of intra-articular type snapping hip have been mentioned in a few reports. Freich et al.4 in 1989 and Atlihan et al.5 in 2003 reported the synovial plica; in 1998, Bellabaraba et al.7 reported joint instability; and in 2004, we11 reported impingement of detached cartilage fragment as a cause of snapping hip. In 1995, McCarthy and Busconi6 reported that, based on arthroscopic findings of coxalgia with unknown cause, 31 of 33 joints manifesting snapping were caused by acetabular labral

Conclusions

  • 1

    Incompatibility between the acetabular labrum and a deformed femoral head was found to be a cause of intra-articular type snapping hip.

  • 2

    Acetabular labral tear was the cause of 80% of the cases of intra-articular type snapping hip.

  • 3

    Local injection of anesthesia into the hip joint together with arthroscopy is very useful for establishing the diagnosis of intra-articular type snapping hip.

  • 4

    Arthroscopy is extremely useful in the surgical treatment of intra-articular type snapping hip.

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