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EP108 Surgical Technique Video: Open Ischiofemoral Decompression with Iliopsoas Reattachment
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EP108 Surgical Technique Video: Open Ischiofemoral Decompression with Iliopsoas Reattachment

Tyler Hauer, Michael S Rocca, Elise B E Raney, Daniel R Lueders, James P Bradley and Craig S Mauro
Journal of hip preservation surgery, Vol.12(Supplement_2), pp.ii75-ii75
12/01/2025
DOI: 10.1093/jhps/hnaf069.236
PMCID: PMC12720773
url
https://doi.org/10.1093/jhps/hnaf069.236View
Published (Version of record) Open Access

Abstract

Last year, he completed a sports medicine fellowship at the University of Toronto Orthopaedic Sports Medicine Program (UTOSM), and is currently completing a second sports medicine fellowship within the Department of Orthopaedic Surgery at UPMC. After completion of his fellowship in Pittsburgh, he will return to Toronto to practice as a sports surgeon. Ischiofemoral impingement (IFI) is an increasingly recognized cause of deep gluteal and posterior hip pain, resulting from pathological narrowing between the ischium and the lesser trochanter, entrapping the quadratus femoris. It is most commonly seen in middle-aged females and presents with symptoms such as pain radiating to the buttock or medial thigh, and occasionally sciatic-like symptoms due to irritation of the sciatic nerve. Clinical diagnosis is supported by provocative tests including the IFI test and long-stride walking test, in conjunction with MRI evidence of a narrowed ischiofemoral space and associated quadratus femoris muscle edema. Initial management is typically non-operative, incorporating physical therapy, activity modification, and image-guided injections into the ischiofemoral space. While many patients respond to conservative treatment, recalcitrant cases may require surgical decompression. Both open and endoscopic techniques have been described for ischiofemoral decompression, including both anterior and posterior approaches, with or without iliopsoas tenotomy. Although surgical management can yield satisfactory pain relief and patient reported outcome measures, outcomes may be compromised by post-operative hip flexion weakness due to iliopsoas detachment. In our surgical technique video we present an open posterior approach to ischiofemoral decompression with iliopsoas reattachment in order to limit potential post-operative hip flexion weakness. Our technique includes an open decompression of the ischiofemoral space with sciatic nerve neurolysis, combined with complete lesser trochanteric osteotomy. Critically, we incorporate iliopsoas tendon reattachment using suture anchor fixation into the osteotomy bed, aiming to preserve postoperative hip flexion strength. This approach offers direct visualization of the sciatic nerve and short external rotators, allows precise bony resection, limits intraoperative fluoroscopy use, and mitigates the risk of nerve injury or persistent hip flexor dysfunction. Preliminary clinical experience has demonstrated favorable early outcomes in terms of pain relief, patient reported outcomes, and preservation of iliopsoas strength.
 Orthopedics Sports Medicine Surgical techniques

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