Abstract
BackgroundPersistent groin pain after total hip arthroplasty (THA) can result from iliopsoas impingement (IPI) on the acetabular rim. Controversy exists over the risks and benefits of tenotomy versus revision as a surgical solution. We report our limited experience with combined acetabular revision and partial iliopsoas tenotomy when other conservative treatments have failed.MethodologyA total of eight patients revised for IPI by a single surgeon at a single institution were retrospectively reviewed after a minimum one-year follow-up. Preoperatively, all patients had prolonged groin pain for a mean of two years (range: 1-4 years) and had failed conservative treatment for at least six months. All patients underwent acetabular revision through a direct anterior approach (DAA) with partial psoas tendon release. No stems were revised. Dislocations, complications, and clinical outcomes are reported in this study.ResultsOf the eight patients, seven had a positive diagnostic challenge with an image-guided injection. All revised cups showed radiographic evidence of IPI with relative acetabular retroversion by either a cross-table lateral film or computed tomography scan. Preoperatively, the mean cup anteversion was 4 degrees (range: 0-9 degrees). Postoperatively, the mean cup anteversion was 19 degrees (range: 16-21 degrees). All cups were within the so-called safe zone. To avoid overstuffing, the mean cup size remained unchanged. There were no major postoperative complications. At a mean time to follow-up of 3.3 years, the mean Hip disability and Osteoarthritis Outcome Score for Joint Replacement was 75 points (range: 32-100 points).ConclusionIPI may be effectively managed with combined acetabular revision and tenotomy. The challenges of implant placement and positioning may be aided with intraoperative imaging through a DAA THA.
Highlights
Iliopsoas impingement (IPI) after total hip arthroplasty (THA) remains a challenging complication in terms of diagnosis and treatment
We retrospectively reviewed a total of eight patients with IPI who underwent revision total hip arthroplasty (rTHA) with partial tenotomy
We agree with other studies that rTHA is a solution of last resort
Summary
Iliopsoas impingement (IPI) after total hip arthroplasty (THA) remains a challenging complication in terms of diagnosis and treatment. It is underrecognized as a cause of persistent groin pain, its incidence has been reported to be as high as 4.3% in a targeted series [1]. Conservative options including physical therapy, anti-inflammatories, and tendon sheath injections have met with limited success. Their utility in the management of IPI may be more helpful diagnostically than therapeutically. The outcome of correcting IPI with acetabular revision has been reported to be successful in relieving symptoms but is marred at times by a complication rate as high as 19.4% [2]. We report our limited experience with combined acetabular revision and partial iliopsoas tenotomy when other conservative treatments have failed
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
