Diagnostics
Often the Coxa saltans is not a clear disease. First of all, a physical examination is necessary, during which the jumping of the iliotibial tract can often already be felt. Sometimes it is even audible.
During an examination in a lying position, the orthopaedic surgeon allows the patient to bend and stretch his outwardly splayed leg (= flexion and extension in adduction position). This should cause the typical symptoms of an existing coxa saltans. Swelling becomes visible when the bursa around the hip joint is inflamed (synovitis/bursitis).
The affected bursa is called bursa subcutanea trochnanertica. No pathological changes are visible in ultrasound (sonography). Likewise, an X-ray image usually remains without pathological findings, unless bony extensions have developed as a result of previous injuries. An MRI can sometimes identify intra-articular causes for coxa saltans.
Conservative therapy
The snapping hip is usually curable. Sometimes it even heals spontaneously. If not, conservative therapy or a surgical alternative is indicated.
With conservative therapy, generally only medication and physical therapy are prescribed and not surgery. In Coxa saltans, NSAIDs (= “non-steroidal anti-inflammatory drugs” such as ibuprofen or diclofenac) are used locally and orally. These are not intended as a permanent therapy and are only used for temporary pain relief.
In severe painful cases, local anaesthetics are injected into the bursa subcutanea trochanterica. Glucocorticoids can also be injected. In some cases, removal of the affected bursa may be considered.
In addition, physiotherapy can help, as well as strength training to compensate for muscular imbalances. Insoles can compensate for the different leg lengths and thus be the treatment of choice for coxa saltans of this cause. A break from sports activities can compensate for the overstrain of the hip apparatus.
Surgical therapy
If the conservative therapy does not help, surgery must be considered. Both the internal coxa saltans and the external coxa saltans can in principle be treated arthroscopically. The arthroscopic procedure is the method of choice for internal coxa saltans.
The psoass tendon is surgically severed. This is also known as “tentotomy”. The arthroscopic procedure is also the method of choice for the external coxa saltans.
In this case, the tractus iliotibialis can be sutured to the greater trochanter if the symptoms persist. A further possibility is the duplication of the muscle fascia or an extension of the tendon. It is also possible to slightly grind the greater trochanter (large rolling mound).
These therapeutic procedures should solve the problem permanently. However, there are also risks with every operation that should be considered, such as possible nerve injuries and damage to the blood vessels, so that the cost-benefit principle should be weighed up. Arthroscopy (joint endoscopy) can have advantages, especially in the area of postoperative wound healing, which should be less complicated in arthoscopy.
Following an operation, intensive physiotherapy must be carried out. Full recovery can take nine to twelve months.
