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I've been told by two surgeons that I need an operation to get rid of a painful, snapping problem in my left hip. Since it is affecting my everyday life and activities, I'm probably going to do it. What should I know about this procedure?

It sounds like you may have a problem called snapping hip. It can be a very annoying and painful condition. As many as one in 10 adults is affected. This figure is higher in certain athletes. Help for the problem usually comes in the form of conservative care including antiinflammatories, rest, and physical therapy. Because there can be more than one thing going on in and around the hip contributing to a snapping hip, diagnosis can take time. Improvement with treatment but without elimination of the symptoms tells the therapist there may be something else contributing to the problem. With patience and persistence, it is possible to successfully treat snapping hip in the majority of affected individuals. If physical therapy is unable to alter the symptoms, then the physician may try injecting the hip. If you have not explored conservative care fully, surgery can be delayed until the full extent of the problem has been examined and treated. But if you have already been down this road without success, then surgery may indeed be your final option. The type of surgery done depends on what's causing the problem. The surgeon may lengthen the iliotibial (IT) band in a procedure called a Z-plasty. The shape of the incision made to lengthen the band is a Z, hence the name. The IT band is a band of connective tissue from the hip down to the knee along the outside of the thigh. This procedure can leave the athlete or dancer with significant hip abduction weakness (moving the leg away from the body). If the snapping is coming from the iliopsoas tendon, the surgeon may lengthen it or release it (cut through it) altogether. Surgery doesn't always take care of the problem. Some patients are still left with the snapping problem -- along with weakness and/or other complications from the surgery. The most common complications associated with iliopsoas release include continued hip pain, numbness along the front of the thigh, nerve palsy, infection, and hip flexor muscle weakness. In some cases, there is more than one problem going on (e.g., labral tear AND iliopsoas tendon rubbing over the bursa). Symptoms can persist until all sources have been removed.

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