Midterm Outcomes of Arthroscopic Treatment for Concomitant Painful External Hip Snapping and Femoroacetabular Impingement Syndrome: A Minimum 5-Year Follow-up Study
Author(s):Quesada-Jimenez R, Sikligar D, Schab AR, Kahana-Rojkind AH, Domb BG.
DOI Link: 10.1177/03635465251404480
Background
Painful external snapping hip (ESH), often related to iliotibial band (ITB) and gluteus maximus tendon pathology, can coexist with femoroacetabular impingement (FAI). While short-term outcomes of concomitant arthroscopic treatment have been favorable, midterm results remain less well defined.
Methods
This Level 3 cohort study retrospectively analyzed patients undergoing primary hip arthroscopy for FAI with concomitant ITB and gluteus maximus tendon release for painful ESH between 2008 and 2019. Inclusion required minimum 5-year follow-up or documented endpoint (revision or conversion to arthroplasty). Patients were propensity matched 1:4 to a control cohort with FAI without ESH based on age, sex, BMI, acetabular cartilage status, labral treatment, and capsular management. Outcomes included PROs (mHHS, NAHS, HOS-SSS, iHOT-12), VAS pain, satisfaction, MCID/PASS achievement, and revision/THA rates.
Key Findings
Patients undergoing combined treatment demonstrated significant improvement in all PROs at ≥5 years.
- 98% achieved resolution of external snapping symptoms
- No revisions were performed for persistent external snapping
- MCID and PASS achievement rates were comparable to controls across all PROs
When compared with the matched FAI-only cohort:
- No differences in postoperative PRO scores or magnitude of improvement
- Similar satisfaction and clinically meaningful threshold achievement
- Comparable revision and conversion to arthroplasty rates
Conclusion
Arthroscopic treatment of FAI with concomitant ITB and gluteus maximus tendon release for painful ESH results in durable midterm improvements and symptom resolution, with outcomes comparable to patients with isolated FAI.
What Does This Mean for Providers?
Concomitant external snapping hip should not be viewed as a negative prognostic factor in patients undergoing hip arthroscopy for FAI. Addressing ITB and gluteus maximus pathology at the time of arthroscopy yields excellent midterm outcomes, near-complete symptom resolution, and no increased risk of reoperation compared with isolated FAI cases.