Hip Pelvis.  2017 Sep;29(3):187-193. 10.5371/hp.2017.29.3.187.

External Snapping Hip Treated by Effective Designed N-plasty of the Iliotibial Band

• Park JS
• Kim WJ
• Lee DW
• Soh JW
• Won SH
• Lee SW
• Moon SI
• Kim HY

• KMID: 2389525
• DOI: http://doi.org/10.5371/hp.2017.29.3.187

Abstract

PURPOSE
The purpose of this study is to present the effective design of N-plasty of the iliotibial band and surgical results of its use as a treatment for refractory external snapping hip.
MATERIALS AND METHODS
We evaluated 17 patients (24 cases) with external snapping hip who underwent N-plasty between October 2013 and May 2016 and who were followed up for at least 12 months. All patients were male and the mean age was 20.8 years. The mean duration of symptoms prior to surgical intervention was 28.5 months with an average follow up of 24.5 months. Surgery was defined as being successful when patients could carry out their daily activities and exercise without a clicking sensation or pain 6 months after surgery until their last follow-up. Failure was defined when either a clicking sensation or pain was present. The visual analog scale (VAS) and modified Harris hip score (mHHS) were measured and compared preoperatively and at last follow-up.
RESULTS
All patients had complete resolution of pain and snapping. The VAS decreased from 6.77 preoperatively to 0.09 postoperatively and mHHS improved from 69.5 to 97.8 after surgery.
CONCLUSION
Modified designed N-plasty is considered to be an excellent treatment method facilitating operation reproducibility with maximum elongation effect of the iliotibial band.

Keyword

Iliotibial band; External snapping hip; N-plasty

MeSH Terms

Follow-Up Studies
Hip*
Humans
Male
Methods
Sensation
Visual Analog Scale

Figure

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  Fig. 1 Magnetic resonance imaging (MRI) examinations. A 21-year-old man with bilateral snapping hip syndrome. The T2-weighted MRI of both hips show thickening and fibrosis of the iliotibial band and greater trochanteric bursitis (arrows).

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  Fig. 2 Diagram of N-plasty design by Yi et al.1) shows incision and transposition of iliotibial band. (A) Proximal flap and distal flap are determined. (B) Proximal flap is sutured cross with distal flap. (C) Suture is performed at each incision edge. (D) Iliotibial band could be lengthened and narrowed.

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  Fig. 3 Clinical photogragh shows the figure of N-plasty on the iliotibial band. GT: greater trochanter.

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  Fig. 4 (A) Anterior and posterior margin lengths are determined by drawing lines from the anterior margin at the area of greater trochanter to proximal and distal portion of posterior margin with 30° of angle each. (B) Design of the N-plasty is accomplished by determined length of the anterior and posterior margin.

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