Skip to main content
SpringerLink
Log in

Treatment Alternatives for Ischiofemoral Impingement

  • Living reference work entry
  • First Online:
Hip Arthroscopy and Hip Joint Preservation Surgery

Abstract

The treatment of ischiofemoral impingement (IFI) is variable from patient to patient. The effects of hip extension limitation on the hip-spine-pelvis-CORE are essential to define the best treatment strategy, and a more aggressive approach is indicated for individuals with secondary biomechanical effects as low back and pelvic pain. Ischiofemoral impingement is treated taking into account all structural levels of the hip joint, i.e., the osseous, capsulolabral, musculotendinous, neurovascular, and the kinematic chain. Additional hip abnormalities may be concomitantly addressed with certain treatment modalities for IFI. This chapter discusses the rationale of the treatment options currently available for IFI. The nonsurgical treatment is presented in the following sections: patient education, correction of leg length inequality, abductor and pelvic muscular strengthening, and injections and medications. In sequence, the surgical alternatives to treat IFI are discussed: endoscopic lesser trochanterplasty and resection, open lesser trochanter resection, ischioplasty, distal transfer of the lesser trochanter, proximal femoral osteotomy varus and derotation osteotomy, and, finally, total hip arthroplasty.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

References

  1. Johnson KA. Impingement of the lesser trochanter on the ischial ramus after total hip arthroplasty. Report of three cases. J Bone Jt Surg Am. 1977;59(2):268–9.

    Article  CAS  Google Scholar 

  2. Patti JW, Ouellette H, Bredella MA, Torriani M. Impingement of lesser trochanter on ischium as a potential cause for hip pain. Skelet Radiol. 2008;37(10):939–41.

    Article  Google Scholar 

  3. Truong WH, Murnaghan L, Hopyan S, Kelley SP. Ischioplasty for femoroischial impingement. J Bone Jt Surg Am. 2012;2(3):2–6.

    Article  Google Scholar 

  4. Hatem MA, Palmer IJ, Martin HD. Diagnosis and 2-year outcomes of endoscopic treatment for ischiofemoral impingement. Arthroscopy. 2015;31(2):239–46.

    Article  Google Scholar 

  5. Gómez-Hoyos J, Khoury A, Schröder R, Johnson E, Palmer IJ, Martin HD. The hip-spine effect: a biomechanical study of ischiofemoral impingement effect on lumbar facet joints. Arthroscopy. 2017;33(1):101–7.

    Article  Google Scholar 

  6. Hatem M, Martin HD. Low back pain improves after surgery for lesser trochanteric-ischial impingement. Arthroscopy. 2021.

    Google Scholar 

  7. Hatem M, Martin RL, Nimmons SJ, Martin HD. Frequency of ischiofemoral space discrepancy when comparing magnetic resonance images of distinct institutions for the same patient. Proc (Bayl Univ Med Cent). 2020;34(2):242–246. https://doi.org/10.1080/08998280.2020.1840184. PMID: 33678956; PMCID: PMC7901394.

  8. Schwarz N, Leixnering M, Hopf R, Jantsch S. Pressure-volume ratio in human cadaver hip joints. Arch Orthop Trauma Surg. 1988;107(5):322–5.

    Article  CAS  Google Scholar 

  9. Yen CH, Leung HB, Tse PYT. Effects of hip joint position and intra-capsular volume on hip joint intra-capsular pressure: a human cadaveric model. J Orthop Surg Res. 2009;4(1):14–6.

    Article  Google Scholar 

  10. Schröder RG, Reddy M, Hatem MA, Gómez-Hoyos J, Toye L, Khoury A, Martin HD. A MRI study of the lesser trochanteric version and its relationship to proximal femoral osseous anatomy. J Hip Preserv Surg. 2015;2(4):410–6.

    PubMed  PubMed Central  Google Scholar 

  11. Hatem M, Khoury AN, Nimmons S, Desantis A, Martin R, Martin HD. Hip-spine extension syndrome: osseous parameters in non-arthritic hips of patients with low-back pain and limitation in hip extension. J Hip Preserv Surg. 2020. Available from: https://academic.oup.com/jhps/advance-article/doi/10.1093/jhps/hnaa054/6008005?login=true

  12. Atkins PR, Fiorentino NM, Aoki SK, Peters CL, Maak TG, Anderson AE. 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(12):2901–10.

    Article  Google Scholar 

  13. Hatem M, Khoury AN, Erickson L, Jones AL, Martin HD. Femoral derotation osteotomy improves hip and spine function in patients with increased or decreased femoral torsion. Arthroscopy. 2020;37(1):111–23.

    Article  Google Scholar 

  14. Hollman JH, Kolbeck KE, Hitchcock JL, Koverman JW, Krause DA. Correlations between hip strength and static foot and knee posture. J Sport Rehabil [Internet]. 2006 Feb 1 [cited 2020 May 25];15(1):12–23. Available from: https://journals.humankinetics.com/view/journals/jsr/15/1/article-p12.xml

  15. DiSciullo AA, Stelzer JW, Martin SD. Dynamic ischiofemoral impingement: case-based evidence of progressive pathophysiology from hip abductor insufficiency: a report of two cases. JBJS Case Connect. 2018;8(4):e107.

    Article  Google Scholar 

  16. Lee S, Kim I, Lee SM, Lee J. Ischiofemoral impingement syndrome. Ann Rehabil Med [Internet]. 2013 [cited 2020 May 4];37(1):143–6. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3604226/

  17. Tosun Ö, Çay N, Bozkurt M, Arslan H. Ischiofemoral impingement in an 11-year-old girl. Diagn Interv Radiol. 2012;18(6):571–3.

    PubMed  Google Scholar 

  18. Yanagishita CMA, Falótico GG, Rosário DAV, Pugina GG, Wever AAN, Takata ET. Ischiofemoral impingement – an etiology of hip pain: case report. Rev Bras Ortop (English Ed) [Internet]. 2012 [cited 2020 May 4];47(6):780–3. Available from: https://linkinghub.elsevier.com/retrieve/pii/S2255497115300392

  19. Nakano N, Shoman H, Khanduja V. Treatment strategies for ischiofemoral impingement: a systematic review. Knee Surg Sport Traumatol Arthrosc [Internet]. 2018 Nov 13 [cited 2020 May 4]. Available from: http://link.springer.com/10.1007/s00167-018-5251-5

  20. Backer MW, Lee KS, Blankenbaker DG, Kijowski R, Keene JS. Correlation of ultrasound-guided corticosteroid injection of the Quadratus Femoris with MRI findings of ischiofemoral impingement. Am J Roentgenol [Internet]. 2014 [cited 2020 May 25]; 589–93. Available from: https://pubmed.ncbi.nlm.nih.gov/25148161/?from_single_result=Correlation+of+ultrasound-guided+corticosteroid+injection+of+the+quadratus+femoris+with+MRI&expanded_search_query=Correlation+of+ultrasound-guided+corticosteroid+injection+of+the+quadratus+femor

  21. Chen YT, Jenkins KM. Ultrasound finding of ischiofemoral impingement syndrome and novel treatment with botulinum toxin chemodenervation: a case report. PM R [Internet]. 2018 Jun 1 [cited 2020 May 25];10(6):665–70. Available from: http://doi.wiley.com/10.1016/j.pmrj.2017.11.010

  22. Ohnishi Y, Suzuki H, Nakashima H, Murata Y, Matsuda DK, Sakai A, Uchida S. Radiologic correlation between the ischiofemoral space and morphologic characteristics of the hip in hips with symptoms of dysplasia. AJR Am J Roentgenol [Internet]. 2018 Mar [cited 2020 May 27];210(3):608–14. Available from: http://www.ncbi.nlm.nih.gov/pubmed/29381377

  23. Fabricant PD, Bedi A, De La Torre K, Kelly BT. Clinical outcomes after arthroscopic psoas lengthening: the effect of femoral version. Arthroscopy. 2012;28(7):965–71.

    Article  Google Scholar 

  24. Hatem M, Nimmons S, Khoury AN, Martin HD. Spinopelvic parameters do not predict the sagittal orientation of the acetabulum. Orthop J Sport Med. 2020;8(10). https://journals.sagepub.com/doi/full/10.1177/2325967120957420

  25. Hatem MA, da Cunha LAM, Abdo JCM, Martin HD. Parameters for assessment of the inferior acetabulum morphology in 300 adult hips. J Hip Preserv Surg [Internet]. 2017 Jan 22 [cited 2019 Oct 29];4(1):97–105. Available from: https://academic.oup.com/jhps/article-lookup/doi/10.1093/jhps/hnw040

  26. Gómez-Hoyos J, Schröder R, Palmer IJ, Reddy M, Khoury A, Martin HD. Iliopsoas tendon insertion footprint with surgical implications in lesser trochanterplasty for treating ischiofemoral impingement: an anatomic study. J Hip Preserv Surg. 2015;2(4):385–91.

    PubMed  PubMed Central  Google Scholar 

  27. Hapa O, Demirkıran ND, Hüsemoğlu B, Edizer M, Havitçioğlu H. Anatomic implications of lesser trochanterplasty. Acta Orthop Traumatol Turc. 2018;52(1):54–7.

    Article  Google Scholar 

  28. Gautier E, Ganz K, Krügel N, Gill T, Ganz R. Anatomy of the medial femoral circumflex artery and its surgical implications. J Bone Jt Surg Br [Internet]. 2000 [cited 2013 May 12];82(5):679–83. Available from: http://www.ncbi.nlm.nih.gov/pubmed/10963165

  29. Ganz R, Slongo T, Turchetto L, Massè A, Whitehead D, Leunig M. The lesser trochanter as a cause of hip impingement: pathophysiology and treatment options. Hip Int. 2013;23(Suppl 9(8)):35–41.

    Article  Google Scholar 

  30. Kalhor M, Horowitz K, Gharehdaghi J, Beck M, Ganz R. Anatomic variations in femoral head circulation. HIP Int [Internet]. 2012 May 13 [cited 2020 Apr 26];22(3):307–12. Available from: http://journals.sagepub.com/doi/10.5301/HIP.2012.9242

  31. Crock HV. An atlas of the arterial supply of the head and neck of the femur in man. Clin Orthop Relat Res. 1980;152:17–27.

    Google Scholar 

  32. Martin H, Shears S, Johnson JC, Smathers A, Palmer IJ. Paper 23: the endoscopic treatment of sciatic nerve entrapment/deep gluteal syndrome. Arthrosc J Arthrosc Relat Surg [Internet]. 2011 Jan [cited 2013 Aug 3];27(1):e13–4. Available from: http://linkinghub.elsevier.com/retrieve/pii/S0749806310011357

  33. Dierckman BD, Guanche CA. Endoscopic proximal hamstring repair and ischial bursectomy. Arthrosc Tech [Internet]. 2012 Dec [cited 2019 Dec 10];1(2):e201–7. Available from: https://linkinghub.elsevier.com/retrieve/pii/S2212628712000369

  34. Hatem M, Teel J, Canavan K, Martin HD. Surgical treatment for ischiofemoral impingement: imaging findings following endoscopic LT plasty. Acta Radiologica. 2021.

    Google Scholar 

  35. Copay AG, Glassman SD, Subach BR, Berven S, Schuler TC, Carreon LY. Minimum clinically important difference in lumbar spine surgery patients: a choice of methods using the Oswestry Disability Index, Medical Outcomes Study questionnaire Short Form 36, and Pain Scales. Spine J [Internet]. 2008 Nov [cited 2019 Oct 3];8(6):968–74. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18201937

  36. Safran M, Ryu J. Ischiofemoral impingement of the hip: a novel approach to treatment. Knee Surg Sport Traumatol Arthrosc. 2014;22(4):781–5.

    Article  Google Scholar 

  37. Hernandez A, Haddad S, Nuñez JH, Gargallo-Margarit A, Sallent A, Barro V. Ischiofemoral impingement syndrome: outcomes of endoscopic resection of the lesser trochanter. Clin Orthop Surg [Internet]. 2017 [cited 2020 May 14];9(4):529. Available from: https://synapse.koreamed.org/DOIx.php?id=10.4055/cios.2017.9.4.529

  38. Ilizaliturri VMJ, Villalobos FEJ, Chaidez PA, Valero FS, Aguilera JM. Internal snapping hip syndrome: treatment by endoscopic release of the iliopsoas tendon. Arthroscopy. 2005;21(11):1375–80.

    Article  Google Scholar 

  39. Wilson MD, Keene JS. Treatment of ischiofemoral impingement: results of diagnostic injections and arthroscopic resection of the lesser trochanter. J Hip Preserv Surg. 2016;3(2):146–53.

    Article  Google Scholar 

  40. Jo S, O’Donnell JM. Endoscopic lesser trochanter resection for treatment of ischiofemoral impingement. J Hip Preserv Surg [Internet]. 2015 Jul 1 [cited 2020 May 14];2(2):184–9. Available from: https://academic.oup.com/jhps/article-lookup/doi/10.1093/jhps/hnv019

  41. Corrales R, Mediavilla I, Margalet E, Aramberri M, Murillo-González JA, Matsuda D. Endoscopic lesser trochanter resection with refixation of the iliopsoas tendon for treatment of ischiofemoral impingement. Arthrosc Tech. 2018;7(4):e321.

    Article  Google Scholar 

  42. Ali AM, Whitwell D, Ostlere SJ. Case report: imaging and surgical treatment of a snapping hip due to ischiofemoral impingement. Skelet Radiol. 2011;40(5):653–6.

    Article  Google Scholar 

  43. Won H, Lee Y-K, Lee B-S, Park JW, Won S, Koo K-H. Normal ischiofemoral distance and its associated factors: computed tomography–based study. Arthroscopy. 2020;36(1):150–5.

    Article  Google Scholar 

  44. Carvalho AD de, Garcia FL, Nogueira-Barbosa MH. Ischiofemoral impingement secondary to valgus intertrochantericosteotomy: a case report. Radiol Bras [Internet]. 2017 [cited 2020 May 16];50(5):335. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5656075/

  45. Hatem M, Canavan K, Dawkins J, Martin RL, Martin HD. Usefulness of magnetic resonance imaging to diagnose greater trochanteric-ischial impingement. Baylor University Medical Center Proceedings. Published online on March 2021. https://www.tandfonline.com/doi/full/10.1080/08998280.2021.1897352

  46. Suren C, Burgkart R, Banke IJ, Hertel G, Schauwecker J, von Eisenhart-Rothe R, Gollwitzer H. Surgical therapy of ischiofemoral impingement by lateralizing intertrochanteric osteotomy. Oper Orthopadie Traumatol. 2018;30:98–110.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Hip Preservation Center, Baylor University Medical Center at Dallas, Dallas, TX, USA

    Munif Hatem & Hal David Martin

Authors
  1. Munif Hatem
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hal David Martin
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA

    Shane J. Nho

  2. Department of Orthopedic Surgery, University of Michigan, Ann Arbor, MI, USA

    Bedi Asheesh

  3. Department of Orthopedic Surgery, Case Western Reserve University, Cleveland, OH, USA

    Michael J. Salata

  4. Department of Orthopedic Surgery, Duke Medical Center, Durham, NC, USA

    Richard C. Mather III

  5. Department of Orthopedic Surgery, Weill Medical College of Cornell Univers, New York, NY, USA

    Bryan T. Kelly

Section Editor information

  1. Houston Methodist Center for Orthopaedics & Sports Medicine, Houston, TX, USA

    Joshua D. Harris

  2. Rush University Medical Center, Chicago, IL, USA

    Joshua D. Harris

Rights and permissions

Reprints and permissions

Copyright information

© 2021 Springer Science+Business Media, LLC, part of Springer Nature

About this entry

Check for updates. Verify currency and authenticity via CrossMark

Cite this entry

Hatem, M., Martin, H.D. (2021). Treatment Alternatives for Ischiofemoral Impingement. In: Nho, S.J., Asheesh, B., Salata, M.J., Mather III, R.C., Kelly, B.T. (eds) Hip Arthroscopy and Hip Joint Preservation Surgery. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-7321-3_147-1

Download citation

  • DOI: https://doi.org/10.1007/978-1-4614-7321-3_147-1

  • Received:

  • Accepted:

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-7321-3

  • Online ISBN: 978-1-4614-7321-3

  • eBook Packages: Springer Reference MedicineReference Module Medicine

Publish with us

Policies and ethics

Search

Navigation