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Ischiofemoral Impingement Surgery Following Lumbar Spine and Sacroiliac Joint Fusion: A Case Report

Vol 8 | Issue 1 | January-June 2022 | page: 11-14 | Steven Gonzales Farrell, Munif Hatem, Hal David Martin

DOI: 10.13107/ti.2022.v08i01.023


Authors: Steven Gonzales Farrell [1], Munif Hatem [2], Hal David Martin [2]

[1] Robert Wood Johnson University Hospital, New Brunswick, New Jersey, United States.
[2] Department of Orthopaedic Surgery, Baylor University Medical Center, Dallas, TX.

Address of Correspondence

Dr Steven Gonzales,
Rutgers Robert Wood Johnson University Hospital, New Brunswick, New Jersey, United States.
E-mail: stevefarrell125@gmail.com


Abstract

Introduction: Ischiofemoral impingement is a cause of posterior hip pain and limitation in hip extension. The compensatory motion at the lumbar spine associated with limitation in hip mobility has been associated with low-back pain, and an increase of 30% in the load at L3-L4 and L4-L5 lumbar facet joint is reported in a cadaveric study involving simulated ischiofemoral impingement.

Case Presentation: A 66-year-old female developed low back pain associated with bilateral hip pain over a period of 12 years. The symptoms persisted despite 5 surgical interventions in the lumbar spine and sacroiliac joints. Impingement between the lesser trochanter and ischium, with limitation of hip extension, was identified on the physical examination and imaging studies. The patient underwent endoscopic partial resection of the lesser trochanter bilaterally. The Oswestry lumbar disability index improved from 56% before surgery to 14% at the 17-month follow-up. Impingement between the lesser trochanter and ischium should be considered in the differential diagnosis of low back pain.

Conclusion: Ischiofemoral impingement should be considered as a differential diagnosis for patients with unsuccessful lumbar spine surgery.

Keywords: Ischiofemoral impingement, Low back pain, Hip pain


References

1. Johnson KA. Impingement of the lesser trochanter on the ischial ramus after total hip arthroplasty. Report of three cases. J Bone Joint Surg Am. 1977;59(2):268-269.

2. Truong WH, Murnaghan L, Hopyan S, Kelley SP. Ischioplasty for Femoroischial Impingement. J Bone Joint Surg Am. 2012;2(3):2-6.

3. Torriani M, Souto SCL, Thomas BJ, Ouellette H, Bredella M a. Ischiofemoral impingement syndrome: an entity with hip pain and abnormalities of the quadratus femoris muscle. AJR Am J Roentgenol. 2009;193(1):186-190.

4. Hatem MA, Palmer IJ, Martin HD. Diagnosis and 2-year outcomes of endoscopic treatment for ischiofemoral impingement. Arthroscopy. 2015;31(2):239-246.

5. Patti JW, Ouellette H, Bredella MA, Torriani M. Impingement of lesser trochanter on ischium as a potential cause for hip pain. Skeletal Radiol. 2008;37(10):939-941. doi:10.1007/s00256-008-0551-3

6. Tosun O, Algin O, Yalcin N, Cay N, Ocakoglu G, Karaoglanoglu M. Ischiofemoral impingement: evaluation with new MRI parameters and assessment of their reliability. Skeletal radiology. 2012;41(5):575-587. doi:10.1007/s00256-011-1257-5.

7. Hatem M, Martin HD. Low Back Pain Improves After Surgery for Lesser Trochanteric–Ischial Impingement. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2021; 37 (5): 1503-1509. doi: 10.1016/j.arthro.2021.01.006.

8. Tosun O, Cay N, Bozkurt M, Arslan H. Ischio femoral impingement in an 11-year-old girl. Diagn Interv Radiol. Published online 2012. doi:10.4261/1305-3825.DIR.5728-12.1

9. 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):101-107.

10. Fairbank JCT, Pynsent PB. The Oswestry Disability Index. Spine. 2000;25(22):2940-2953.

11. 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. The American journal of sports medicine. 2017;45(12):2901-2910.

12. 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 connector. 2018;8(4):e107.

13. Siebenrock KA, Steppacher SD, Haefeli PC, Schwab JM, Tannast M. Valgus hip with high antetorsion causes pain through posterior extraarticular FAI. Clinical orthopaedics and related research. 2013;471(12):3774-3780.

14. Morris WZ, Fowers CA, Weinberg DS, Millis MB, Tu LA, Liu RW. Hip morphology predicts posterior hip impingement in a cadaveric model. HIP International. 2019;29(3):322-327.


How to Cite this article: Farrell SG, Hatem M, Martin HD | Ischiofemoral Impingement Surgery Following Lumbar Spine and Sacroiliac Joint Fusion: A Case Report | January-June 2022; 8(1): 11-14.

 


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