An operative technique for psoas impingement following total hip arthroplasty: a case series of day case, extra articular, arthroscopic psoas tenotomy

Abstract

We present a prospective case series of patients undergoing an arthroscopic, extra-articular psoas tenotomy. From February 2009 to February 2017, 13 consecutive patients underwent day case, arthroscopic tenotomy. Patients were selected following clinical evidence of impingement and a diagnostic ultra-sound-guided steroid injection of the psoas bursa. The patient's mean age was 52.8years ± 13.7 (29.1-82.7), mean ASA 1.8 and mean BMI 30.6±8.5kg/m2. We detail the technique employed and patient outcomes to include FABER testing, manual hip flexion strength assessment and pain improvements. The typical onset of impingement symptoms following THA was 4months (2-24months). 9 patients tested FABER negative and 62% (n = 8) were pain-free within 6-12 weeks. An average 20% (5-30%) reduction in hip flexion strength was seen post-arthroscopy. The mean follow-up was 2 years, (0.5-7years). Regarding complications, one patient required revision surgery due to recurrence prompting a technique adaptation. For psoas impingement following THA where non-operative measures are ineffective, we recommend extra-articular arthroscopic psoas tenotomy as a feasible operative strategy. This minimally invasive, day case, low-risk treatment option is beneficial in relieving impingement symptoms.