Low back pain improves after surgery for lesser trochanteric-ischial impingement

Purpose: To assess the effects of surgery for lesser trochanteric-ischial impingement (LTI) on low back pain.

Methods: The records of patients with LTI who underwent endoscopic partial resection of the lesser trochanter (LT) between May of 2017 and February of 2019 were reviewed. The inclusion criteria were: presence of low back pain in association with hip pain, diagnosis of LTI, and partial resection of the LT to treat LTI. The exclusion criteria were less than 12 months of post-operative follow-up, and hip or spine surgery after the LTI surgery. Patients were assessed before surgery and at the most recent follow-up with the modified Harris hip score (mHHS) and Oswestry disability index (ODI) for lumbar spine.

Results: Thirty patients (31 hips) met the inclusion criteria. Four patients were lost to follow-up. Two patients with borderline dysplasia and grade 1 and 2 osteoarthritis underwent total hip arthroplasty after the partial resection of the LT. The results are presented considering the remaining 24 patients (25 hips). The average age at surgery was 51 years (range, 32 to 65 years). The mean follow-up after the surgery for LTI was 19 months (range, 12 to 35 months). The mean ± SD ODI improved from 48% ± 15 before the LTI surgery to 21% ± 22 (p<0.001) at the most recent follow-up. Improvement in the ODI above the minimal clinical important difference (MCID) was observed in 16 patients (67%) following the LTI surgery. The mean ± SD mHHS improved from 55.8 ± 14 before LTI surgery to 81.3 ± 14.3 (p<0.001).

Conclusion: Decrease in low back pain above the minimal clinically important difference is observed in 2 out of 3 patients after partial resection of the LT.

Level of evidence: Level IV, therapeutic case series.