Abstract
BackgroundAs a recognized cause of groin pain following total hip arthroplasty, iliopsoas tendonitis probably results from different factors. Given the anatomic disadvantage, dysplastic hips theoretically make acetabular component relatively retroverted or oversized, screws implanted frequently, and iliopsoas tendonitis more likely. However, the prevalence and mechanism of iliopsoas tendonitis following total hip replacement in dysplastic hips are not fully understood.MethodsOne hundred and thirty-three total hip arthroplasties for Crowe type 2 to 4 dysplastic hips were compared with 126 total hip arthroplasties for hips without dysplasia in this study. Preoperative patient demographic data were well matched between the groups. Clinical and radiographic evaluations were performed.ResultsA significantly higher frequency of protruded screws (24.8% vs 0), anterior overhang of acetabular components (30.8% vs 4.0%), and increased leg lengthening (3.6 [2.0–6.8] vs 0.5 [0–1.8]) was found in the dysplastic group (all p values < 0.05). However, the femoral offset and inclination and anteversion of acetabular components between the groups did not differ significantly. No difference in the prevalence of iliopsoas tendonitis was found between the groups. A new cause of iliopsoas tendonitis following total hip arthroplasty was detected in the dysplastic group. The iliopsoas tendonitis was irritated by an instable artificial femoral head.ConclusionsThe dysplastic hips did not present a higher incidence of postoperative iliopsoas tendonitis in this study. Iliopsoas tendonitis could be somewhat prevented by smaller size of acetabular components and soft tissue release in dysplastic hips, but irritated by an instable artificial femoral head.
Highlights
As a recognized cause of groin pain following total hip arthroplasty, iliopsoas tendonitis probably results from different factors
Given the anatomic disadvantage of dysplastic hips, we addressed the following questions: (1) How to define the risk of anteriorly oversized acetabular components, protruded screws, and increased leg length following total hip replacement in highly (Crowe type 2 to 4) dysplastic hips? (2) Do highly dysplastic hips present a higher incidence of postoperative iliopsoas tendonitis? (3) Is there any other factors related to postoperative iliopsoas tendonitis?
Highly dysplastic hips did not present a higher incidence of postoperative iliopsoas tendonitis in this study
Summary
As a recognized cause of groin pain following total hip arthroplasty, iliopsoas tendonitis probably results from different factors. Dysplastic hips theoretically make acetabular component relatively retroverted or oversized, screws implanted frequently, and iliopsoas tendonitis more likely. The prevalence and mechanism of iliopsoas tendonitis following total hip replacement in dysplastic hips are not fully understood. Total hip arthroplasty in dysplastic hips presents specific difficulties including reduced acetabulum depth, anterolateral and superior acetabular bone deficiency, leg length discrepancy, and muscular contractures. These features are relatively severe in Crowe type 2 to 4 [11, 12] dysplastic hips. These features make the acetabular component relatively retroverted or anteriorly oversized, screws implanted frequently, and
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