title: Extra-articular hip impingement: a systematic review examining operative treatment of psoas, subspine, ischiofemoral, and greater trochanteric/pelvic impingement.
abstract: OBJECTIVE
  Extra-articular hip impingement can be the result of psoas impingement (PI), subspine impingement (SSI), ischiofemoral impingement (IFI), and greater trochanteric/pelvic impingement (GTPI). Symptoms may be due to bony abutment or soft-tissue irritation, and often, it is a challenge to differentiate among symptoms preoperatively. Currently, the clinical picture and diagnostic criteria are still being refined for these conditions. This systematic review was conducted to examine each condition and elucidate the indications for, treatment options for, and clinical outcomes of surgical management.
  
  
  METHODS
  We searched online databases (Medline, Embase, and PubMed) for English-language clinical studies published from database inception through December 31, 2013, addressing the surgical treatment of PI, SSI, IFI, and GTPI. For each condition, 2 independent assessors reviewed eligible studies. Descriptive statistics are presented.
  
  
  RESULTS
  Overall, 9,521 studies were initially retrieved; ultimately, 14 studies were included examining 333 hips. For PI, arthroscopic surgery resulted in 88% of patients achieving good to excellent results, as well as significant improvements in the Harris Hip Score (P = .008), Hip Outcome Score-Activities of Daily Living (P = .02), and Hip Outcome Score-Sport (P = .04). For SSI, arthroscopic decompression, with no major complications, resulted in a mean 18.5° improvement in flexion range of motion, as well as improvements in pain (mean visual analog scale score of 5.9 points preoperatively and 1.2 points postoperatively) and the modified Harris Hip Score (mean of 64.97 points preoperatively and 91.3 points postoperatively). For both IFI and GTPI, open procedures anecdotally improved patient symptoms, with no formal objective outcomes data reported.
  
  
  CONCLUSIONS
  This review suggests that there is some evidence to support that surgical treatment, by arthroscopy for PI and SSI and by open surgery for IFI and GTPI, results in improved patient outcomes.
  
  
  METHODS
  Systematic review of Level IV and V (case report) studies.
authors.affiliation: Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Centre, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Darren
authors.initials: D
authors.lastname: de Sa
authors.affiliation: Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Centre, McMaster University, Hamilton, Ontario, Canada; Ministry of Higher Education, Riyadh, Saudi Arabia.
authors.forename: Hussain
authors.initials: H
authors.lastname: Alradwan
authors.affiliation: Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Cargnelli
authors.affiliation: Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Zoyah
authors.initials: Z
authors.lastname: Thawer
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Nicole
authors.initials: N
authors.lastname: Simunovic
authors.affiliation: Raleigh Orthopaedic Clinic, Raleigh, North Carolina.
authors.forename: Edwin
authors.initials: E
authors.lastname: Cadet
authors.affiliation: Lyon-Ortho-Clinic, Lyon, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Bonin
authors.affiliation: Minnesota Orthopedic Sports Medicine Institute at Twin Cities Orthopedics, Edina, Minnesota, U.S.A.
authors.forename: Christopher
authors.initials: C
authors.lastname: Larson
authors.affiliation: Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Centre, McMaster University, Hamilton, Ontario, Canada. Electronic address: ayenif@mcmaster.ca.
authors.forename: Olufemi R
authors.initials: OR
authors.lastname: Ayeni
mesh_terms: D001182:Arthroscopy; D006615:Hip / Q000601:surgery*; D006621:Hip Joint / Q000601:surgery; D006801:Humans; D007592:Joint Diseases / Q000601:surgery*