EP3.12 Posterior Endoscopic Treatment of Ischiofemoral Impingement in the Lateral Decubitus Position: Selective Posterior Lesser Trochanter Osteoplasty Technique

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ID: 331202
2026
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Abstract
Abstract Ischiofemoral impingement (IFI) is an increasingly recognized cause of posterior hip pain, resulting from narrowing between the lesser trochanter and the ischium with compression of the quadratus femoris muscle. It frequently coexists with Femoroacetabular impingement (FAI) and may remain underdiagnosed, particularly in patients with persistent symptoms after hip arthroscopy. We report the case of a 51-year-old female with progressive bilateral hip pain who underwent bilateral hip arthroscopy for FAI, with only partial symptom relief. Persistent posterior hip pain and snapping prompted further evaluation. Magnetic resonance imaging demonstrated marked narrowing of the ischiofemoral space and quadratus femoris atrophy, consistent with IFI. The patient underwent posterior endoscopic ischiofemoral decompression in the lateral decubitus position. A posterolateral approach to the deep gluteal space was performed using the quadratus femoris as the primary anatomical landmark. The sciatic nerve was systematically sought, although direct visualization was not always possible. The quadratus femoris was used to define a safe working corridor, with instruments consistently oriented toward bone. Continuous manual neurodynamic monitoring of the limb by the assistant was maintained throughout the procedure. Selective osteoplasty of the posterior and posteromedial aspect of the lesser trochanter was performed under fluoroscopic guidance, preserving the iliopsoas insertion. Dynamic intraoperative assessment confirmed adequate decompression. IFI is a posterior, extra-articular, and position-dependent condition that may not be adequately addressed through anterior arthroscopic approaches. The lateral decubitus position provides favorable access to the posterior hip, facilitates dynamic assessment, and allows safe management of the deep gluteal space when appropriate anatomical landmarks and neuroprotective strategies are used. This case supports posterior endoscopic decompression in the lateral decubitus position as a safe, reproducible, and effective technique for the surgical management of symptomatic IFI.
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Authors Rúben Dias, João Morais, Gonçalo Calvário, Dra Frederica Biscaia, Filipe Castelo, Manuel Godinho, Sílvio Dias, Carlos Branco
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Journal Journal of hip preservation surgery
Year 2026
DOI
10.1093/jhps/hnag043.297
URL
https://doi.org/10.1093/jhps/hnag043.297
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