Endoscopic Iliopsoas Fractional Lengthening as a Treatment for Refractory Iliopsoas Impingement After Total Hip Arthroplasty Shows Favorable Functional Outcomes With No Impact In Range of Motion

Abstract

To report the minimum 2-year clinical outcomes of endoscopic iliopsoas fractional lengthening (IFL) in patients with recalcitrant iliopsoas tendonitis after Total hip arthroplasty (THA). Data was prospectively collected from 2014 to 2020 for patients who underwent IFL following primary THA as part of the institutional hip outcomes registry. Patients were included if they had completed preoperative and minimum 2-year follow-up the following patients reported outcomes (PROs): modified Harris Hip Score (mHHS) and, visual analog scale (VAS). Preoperative and postoperative data was available for the International Hip Outcomes Tool (iHOT-12), and patient satisfaction was also analyzed. Patients included in the study reported irritation of the iliopsoas tendon following cementless THA, refractory to conservative treatment methods. IFL was recommended after workup which included ruling out infection and aseptic loosening, and a positive iliopsoas diagnostic injection. Seventeen patients were included in the study . The mean age at IFL was 56.42 (30.17-81.29). The mean interval between THA and IFL was 2.72 (0.25-8.34) years. There was a significant improvement in all evaluated PROs, and a high percentage of patients meeting MCID (14 (82.35%) for mHHS, 11 (92.00%) for iHOT-12, and 16 (94.12%) for VAS (p < 0.05). Furthermore 15 (88.2%) of patients reported a positive response to the PASS anchor question. No impact was observed from pre-to postoperative active range of motion and no patient reported weakness at the latest follow up (p > 0.05). Preoperative flexion was 106.33° (85.0°-120.0°) and post-operative flexion was 106° (900°-120.00). Endoscopic IFL yielded significant improvements in functional outcomes with a high patient satisfaction at minimum 2-year follow-up, with no reported complications. This procedure did not have a significant negative impact on hip range of motion. Retrospective Case Series; Level IV.