What is Ischiofemoral Impingement?
Ischiofemoral impingement is a condition in which there is an abnormal contact (impingement) between the soft tissues of the thigh bone and hip due to the narrowing of space between the lesser trochanter and ischium, resulting in significant hip pain.
Athletes or very active individuals who place a lot of stress on their hip joint are likely to suffer from ischiofemoral impingement, and women are more likely to be affected than men. Ischiofemoral impingement may affect both sides of the hip, but symptoms may manifest only on one side.
Causes of Ischiofemoral Impingement
Ischiofemoral impingement is caused by entrapment or compression of soft tissue in the ischiofemoral space present between the upper part of the thighbone (femur) and the lower back part of the hip bone (ischium). Normally, these 2 bones contact in a manner that allows them to move without any pain, but overuse, trauma, and prior surgery can injure the bone. In some cases, this injury can cause the growth of excess bone, called a bone spur, on the femur or hip. This excess bone can rub against the hip and thigh bones, causing more injury and worsening the condition further.
Signs and Symptoms of Ischiofemoral Impingement
Signs and symptoms of ischiofemoral impingement include:
- Pain in the buttocks, hip, and groin area
- Presence of oedema and inflammation in the ischiofemoral space
- A clicking, snapping, or locking sensation in the hip joint during activities such as walking
- Crepitus - cracking or popping sound in the hip joint
- Stiffness and limited range of motion of the hip joint
Diagnosis of Ischiofemoral Impingement
To determine the underlying cause of ischiofemoral impingement, your doctor will review your symptoms and medical history, perform a physical examination, and order certain diagnostic tests.
During the physical examination, your doctor will try to feel for certain weak points in the hips that indicate ischiofemoral impingement. Other diagnostic tests employed include plain radiographs or X-rays, ultrasound studies of the hip and surrounding structures, and MRI.
Treatment for Ischiofemoral Impingement
Treatments for ischiofemoral impingement involves both conservative management and surgical management. If conservative management fails to alleviate symptoms, then the surgical option is recommended.
- Conservative management is always the first line of treatment where your doctor recommends physical therapy, activity modification, non-steroidal anti-inflammatory drugs, ultrasound, electrical stimulation, and shock wave therapy.
- Surgical management includes ischiofemoral impingement decompression and involves resection or reshaping of bone and distalization (slightly shifting the position of the bone to open up the ischiofemoral space).
Procedure for Ischiofemoral Impingement Decompression
Ischiofemoral impingement decompression surgery can be performed arthroscopically or through open surgery. Your surgeon will decide which approach is the best for your condition. The surgery is usually performed arthroscopically as a minimally invasive procedure. An arthroscope is a small, fibre-optic instrument consisting of a lens, light source, and video camera. The camera projects images of the inside of the joint onto a monitor, allowing your surgeon to look for damage, assess the severity of the injury, and perform the needed repairs.
The arthroscopic procedure is performed under regional or general anaesthesia with you lying on your back on the operating table. After adequately sterilising the surgical area, a few small incisions will be made through which the arthroscope and tiny surgical instruments will be inserted. Reshaping of bone will be performed to decompress the impinged tissue. The leg will be moved in various directions to check for a satisfactory range of motion. Once the decompression is confirmed, the arthroscope and instruments are removed, the incisions are closed with absorbable sutures, and a bandage is applied.