Iliopsoas Pathology: Game-changing Findings from a Large Hip Arthroscopy Study Group

Abstract

Report the prevalence, associated findings, rendered arthroscopic surgical procedures, and outcomes of hips with iliopsoas-related pathology. Enrolled patients that underwent isolated hip arthroscopy that reached 2-year minimum PRO follow-up were assigned to Iliopsoas group, defined as pre-operative diagnosis of iliopsoas tendonitis, internal snapping hip symptoms, history of psoas injection, and/or intra-operative anteroinferior labral bruising or tear or the control group. The prevalence of iliopsoas-related pathology, radiographic and intra-operative findings, and rendered procedures between study and control groups were compared using Chi square analysis. Minimum 2-year outcomes were compared using analysis of variance (a priori alpha set at 0.05). 629 patients met the inclusion criteria of which 69 patients (11%) comprised the iliopsoas group and 560 patients (89%), the control group. Iliopsoas tenotomy was performed in 5 patients, all via the transcapsular approach. Demographics did not differ between groups (p>0.05). There was no significant difference in the prevalence of cam deformity, global pincer deformity, or dysplasia between cohorts but there was a lower incidence of focal pincer impingement among patients with iliopsoas involvement (22 % vs 37%,p=0.001). Labral repair and debridement was more commonly performed in the group of patients without iliopsoas involvement and relatively more labral reconstructions in the iliopsoas group (p<0.05). Post-operative iHOT-12 scores similarly improved to 70.2 (SD:26.7) for the iliopsoas group and 73.0 (SD:25.1) for the control group (p=0.68). Post-operative pain scores similarly reduced to 21.9 (SD 23.0) for the iliopsoas group and 20.2 (SD: 22) for the control group (p=0.74). The most significant finding from this large multicenter study is the extremely low incidence of arthroscopic iliopsoas tenotomies despite the not uncommon prevalence of iliopsoas-related pathology. The incidence of iliopsoas tenotomy has significantly decreased in patients undergoing hip arthroscopy and the presence of iliopsoas–related pathology even untreated with tenotomy is not a predictor of poorer outcomes.