Editorial Commentary: Indications for Concurrent Procedures During Hip Femoroacetabular Impingement Arthroscopic...

In patients with femoroacetabular impingement (FAI), hip joint pathology often leads to an alteration of gait as well as core and pelvic muscular imbalance. Flexor, abductor, adductor, and hamstring tightness and pain are common patient-reported complaints at the time of evaluation for FAI and potential hip arthroscopy. Surgical interventions have been developed to target all of these potential issues, but the question remains whether these concurrent procedures are necessary, or whether postoperative rehabilitation and other conservative measures may better treat associated conditions. We recommend that iliotibial band release is not indicated for patients with nonsnapping extra-articular lateral hip pain and should be reserved for frank, external snapping hip. Patients with lateral hip pain that prevents them from lying on their side at night are candidates for endoscopic trochanteric bursectomy through a minimal longitudinal ITB incision. Patients with evidence of gluteus medius pathology including positive Trendelenburg test, Trendelenburg gait, or pain with resisted hip abduction are treated with either bioinductive patch gluteus medius tendon augmentation or endoscopic or open abductor repair. The challenge is determining which of these associated conditions are compensatory (i.e., will improve after the underlying hip pathology is addressed during FAI surgery), and which are pathologic (i.e., must separately be addressed at the time of surgery).