PURPOSE A snapping hip (coxa saltans) secondary to a tight iliotibial band rarely needs surgical intervention. The purpose of this study is to present the surgical results of refractory external-type snapping hip by Z-plasty of the iliotibial band. MATERIALS AND METHODS Nine symptomatic snapping hips in 8 consecutive patients (1 bilateral) from August 1997 through March 2002 who underwent an iliotibial band Z-plasty were reviewed. RESULTS Eight of the 9 hips were in active-duty military and 1 was a civilian, with an average age of 25.6 years (range, 21 to 38 years). Mean duration of symptoms prior to surgical intervention was 25.2 months (range, 16 to 39 months) with an average follow-up of 22.9 months (range, 7 to 38 months). All patients had complete resolution of the snapping hip, and all but 1 returned to full unrestricted activities. The 1 failure had persistent groin pain but no residual snapping. CONCLUSIONS Patients with snapping hip of the iliotibial band refractory to conservative treatment are rare. The surgical results of Z-plasty are excellent and predictable. Careful screening is necessary to preclude other confounding diagnoses. Z-plasty is recommended as an effective surgical treatment of the refractory snapping hip secondary to iliotibial band tightness.