Greater trochanteric-pelvic impingement

Greater trochanteric-pelvic impingement is an extra-articular or external type of hip impingement

Terminology

Greater trochanteric-pelvic impingement is also known as ‘pelvitrochanteric impingement’ or ‘trochanteric impingement’ .

Epidemiology

Greater trochanteric-pelvic impingement seems to be more common in younger people .

Risk factors

Perthes disease
slipped capital femoral epiphysis
infantile coxa vara
previous traumatic injury or hip infection

Clinical presentation

Chief complaints are pain while walking, limping decreased range of motion in the affected hip joint and/or impaired abduction .

Pathology

Impingement is caused between the greater trochanter and the ilium or posterior rim of the acetabulum on hip abduction from full extension in patients with a shortened femoral neck. This can occur as a sequel of Perthes disease or slipped capital femoral epiphysis . Since recently previous total hip replacement has also been discussed as a possible etiology .

Radiographic features

Radiographic features include the following:

reduced distance between the greater trochanter and the ilium
shortened femoral neck length

Treatment and prognosis

Treatment options include conservative approaches with activity modification physical and manual therapy, as well as nonsteroidal anti-inflammatory drugs. For more severe symptoms e.g. limping lateralizing osteotomy or a combination of femoral head-neck osteochondroplasty and relative femoral neck lengthening are surgical options .