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Portet A, Repellin M, Lambrey PJ, Benhenneda R, Vieira TD, Thaunat M. Assessment of function and muscle strength after endoscopic iliopsoas tenotomy to treat iliopsoas impingement after total hip arthroplasty. INTERNATIONAL ORTHOPAEDICS 2024:10.1007/s00264-024-06228-y. [PMID: 38833166 DOI: 10.1007/s00264-024-06228-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 05/22/2024] [Indexed: 06/06/2024]
Abstract
PURPOSE The objective of this study was to evaluate the functional outcome during follow-up (FU) after endoscopic tenotomy for iliopsoas (IP)-cup impingement and to quantitatively analyze the hip flexion strength. METHODS This was a monocentric, retrospective cohort study of a single surgeon series. Functional assessment was based on the modified Harris score, the Oxford score and the visual analog scale score. Strength was measured with a handheld dynamometer in the sitting and lying position. RESULTS Thirty-six IP tenotomies for cup impingement were performed between May 2013 and November 2021. Seven (19%) patients were lost to FU. At the time of tenotomy, the mean (standard deviation) age was 62,6 (12,2) and BMI was 26,5 (4,1). The mean FU time after tenotomy to the last FU was 3,6 (0,8) years. All three outcome scores improved from preoperatively to six months postoperatively (p < 0.001). There were no significant change from six months to last FU. The minimal clinically important difference (MCID) of the modified Harris score was set at 25. 20 (69%) patients had values that exceeded the threshold at one month and six months and neutral 19 (65.5%) had values that exceeded the threshold at the last FU. The limp symmetry index concerning hip flexion strength was 63% at 90° and 40% at 30° at the last FU. CONCLUSION Most patients significantly improved their outcome scores after endoscopic iliopsoas tenotomy, with results remaining consistently stable over time. Despite a significant loss in hip flexion strength, the majority of patients did not report any impairment of their quality of life. STUDY DESIGN Level III, Retrospective cohort study.
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Affiliation(s)
- Adrien Portet
- Centre Orthopédique Santy, Ramsay Santé, Hôpital privé Jean Mermoz, FIFA Medical Center of Excellence, 24, Avenue Paul Santy, Lyon, 69008, France
| | - Mathieu Repellin
- Centre Orthopédique Santy, Ramsay Santé, Hôpital privé Jean Mermoz, FIFA Medical Center of Excellence, 24, Avenue Paul Santy, Lyon, 69008, France
| | - Pierre-Jean Lambrey
- Centre Orthopédique Santy, Ramsay Santé, Hôpital privé Jean Mermoz, FIFA Medical Center of Excellence, 24, Avenue Paul Santy, Lyon, 69008, France
| | - Rayane Benhenneda
- Centre Orthopédique Santy, Ramsay Santé, Hôpital privé Jean Mermoz, FIFA Medical Center of Excellence, 24, Avenue Paul Santy, Lyon, 69008, France
| | - Thais Dutra Vieira
- Centre Orthopédique Santy, Ramsay Santé, Hôpital privé Jean Mermoz, FIFA Medical Center of Excellence, 24, Avenue Paul Santy, Lyon, 69008, France
| | - Mathieu Thaunat
- Centre Orthopédique Santy, Ramsay Santé, Hôpital privé Jean Mermoz, FIFA Medical Center of Excellence, 24, Avenue Paul Santy, Lyon, 69008, France.
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Sterneder CM, Tüngler TL, Haralambiev L, Boettner CS, Boettner F. Pelvic Roll Back Can Trigger Functional Psoas Impingement in Total Hip Arthroplasty. Arthroplast Today 2024; 27:101375. [PMID: 38680848 PMCID: PMC11047294 DOI: 10.1016/j.artd.2024.101375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 03/06/2024] [Accepted: 03/06/2024] [Indexed: 05/01/2024] Open
Abstract
In most cases, impingement of the iliopsoas tendon after total hip arthroplasty is caused by acetabular component retroversion. The present case report describes a patient with functional iliopsoas impingement following total hip arthroplasty. With increasing flexibility of the hip joint after surgery, the functional adjustment to the stiff thoracolumbar spine in this patient with diffuse idiopathic skeletal hyperostosis resulted in progressive pelvic roll back. This roll back resulted in a functional iliopsoas impingement as the psoas tendon travels over the front of the pecten ossis pubis. Since excessive roll back is usually also addressed in primary total hip arthroplasty by decreasing anteversion of the acetabular component, surgeons should be aware to avoid the combination of roll back and decreased anteversion and their potential impact on iliopsoas impingement.
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Affiliation(s)
| | - Tim Ludwig Tüngler
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY, USA
| | - Lyubomir Haralambiev
- Center for Orthopaedics, Trauma Surgery and Rehabilitation Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Cosima S. Boettner
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY, USA
| | - Friedrich Boettner
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY, USA
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Erard J, Viamont-Guerra MR, Bonin N. Satisfactory mid-term clinical outcomes of endoscopic tenotomy for iliopsoas tendinopathy following total hip arthroplasty. Knee Surg Sports Traumatol Arthrosc 2024; 32:1216-1227. [PMID: 38515260 DOI: 10.1002/ksa.12103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 02/07/2024] [Accepted: 02/12/2024] [Indexed: 03/23/2024]
Abstract
PURPOSE To report 5-year outcomes of endoscopic iliopsoas tenotomy in patients with iliopsoas tendinopathy following total hip arthroplasty (THA) and determine whether clinical scores are associated with cup position. METHODS Patients who underwent endoscopic iliopsoas tenotomy for iliopsoas tendinopathy following THA (2014-2017) were contacted. Indications for endoscopic iliopsoas tenotomy after THA were groin pain during active hip flexion, exclusion of other causes of groin pain, and no pain relief after 6 months of conservative treatment. Pretenotomy cup inclination and anteversion were measured on radiographs; axial and sagittal cup overhang were measured on computed tomography (CT) scans. Oxford hip score (OHS), modified Harris hip score (mHHS), and groin pain were assessed. RESULTS The initial cohort comprised 16 men (17 hips) and 31 women (32 hips), aged 60.7 ± 10.6 years. Cup inclination and anteversion were, respectively, 46.2 ± 6.2° and 14.6 ± 8.4°, while axial and sagittal cup overhang were, respectively, 4.4 ± 4.0 mm and 6.9 ± 4.5 mm. At ≥5 years follow-up, four hips underwent cup and stem revision, two underwent isolated cup revision and one underwent secondary iliopsoas tenotomy. OHS improved by 23 ± 10 and mHHS improved by 31 ± 16. Posttenotomy groin pain was slight in 20.0%, mild in 17.5% and moderate in 12.5%. Regression analyses revealed that net change in mHHS decreased with sagittal cup overhang (β = -3.1; 95% confidence interval [CI] = -4.6 to -1.7; p < 0.001), but that there were no associations between cup position and net change in OHS. CONCLUSIONS Endoscopic iliopsoas tenotomy provides good mid-term clinical outcomes in patients with iliopsoas tendinopathy following THA. Furthermore, improvements in mHHS were found to decrease with increasing sagittal cup overhang, in cases for which adequate preoperative imaging was available. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Julien Erard
- Lyon Ortho Clinic, Clinique de la Sauvegarde, Lyon, France
| | - Maria-Roxana Viamont-Guerra
- Lyon Ortho Clinic, Clinique de la Sauvegarde, Lyon, France
- Hospital Israelita Albert Einstein, Morumbi, São Paulo, Brazil
| | - Nicolas Bonin
- Lyon Ortho Clinic, Clinique de la Sauvegarde, Lyon, France
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Li Y, Yv H, Ni R, Liao Y, Qin Z, Jia D. Sequential Treatment of Iliopsoas Tendon Cysts Combined With Medial Hip Snapping by Hip Arthroscopy. Arthrosc Tech 2024; 13:102925. [PMID: 38835448 PMCID: PMC11144725 DOI: 10.1016/j.eats.2024.102925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 12/22/2023] [Indexed: 06/06/2024] Open
Abstract
Tendon cysts of the iliopsoas muscle cause pain and snapping of the hip. These cysts are close to the femoral nerve and blood vessels, and the risk of open surgery is high, with cyst recurrence occurring frequently. We describe a method of hip arthroscopy for the orderly excision of iliopsoas cysts. During the operation, the iliopsoas tendon is identified and released, the cyst is excised, and peritendinous osteophytes are formed successively. This technique is a minimally invasive, safe, and highly effective hip arthroscopy technique that addresses both intra- and extra-articular lesions.
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Affiliation(s)
- Yanlin Li
- Department of Sports Medicine, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Hong Yv
- Department of Sports Medicine, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Rongqian Ni
- Department of Reproduction and Genetics, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yatong Liao
- Department of Sports Medicine, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Zhen Qin
- School of Sociological and Anthropological Studies, Faculty of Social Sciences, University of Ottawa, Ottawa, Canada
| | - Di Jia
- Department of Sports Medicine, The First Affiliated Hospital of Kunming Medical University, Kunming, China
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Hevesi M, Lee DR, Wang AS, Krych AJ, Levy BA. Arthroscopic Iliopsoas Fractional Lengthening After Total Hip Arthroplasty: Using the Iliopsoas Air Bursogram Technique to Hit the Target. Arthrosc Tech 2023; 12:e2111-e2116. [PMID: 38196874 PMCID: PMC10772925 DOI: 10.1016/j.eats.2023.07.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 07/19/2023] [Indexed: 01/11/2024] Open
Abstract
Iliopsoas tendinitis following total hip arthroplasty has been linked to retroverted acetabular cup position with associated anterior overhang. For severely malpositioned components, preferred treatment is in the form of revision arthroplasty. However, for a substantial number of cases, iliopsoas tendinitis as well as associated pain and disability are observed in the presence of modest acetabular overhang. In such cases, patients may benefit substantially from arthroscopic iliopsoas fractional lengthening. Given altered postarthroplasty anatomy, we present an arthroscopic approach employing an iliopsoas air bursogram. In such a way, safe and predictable access can be provided for efficient tendon lengthening without capsular violation or inadvertent instrumentation of the nearby medial neurovascular bundle.
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Affiliation(s)
- Mario Hevesi
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Dustin R. Lee
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Allen S. Wang
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Aaron J. Krych
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Bruce A. Levy
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
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Lambrey PJ, Bonin N, Thaunat M, Gédouin JE, Flecher X, Wettstein M, Guicherd W, Prevot N, May O. What happens to endoscopic/arthroscopic tenotomies with iliopsoas impingement in the medium term? Review of a prospective cohort of 64 patients with a minimum follow-up of 5 years. Orthop Traumatol Surg Res 2023; 109:103687. [PMID: 37717656 DOI: 10.1016/j.otsr.2023.103687] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/04/2023] [Accepted: 08/22/2023] [Indexed: 09/19/2023]
Abstract
INTRODUCTION The occurrence of iliopsoas impingement (IPI) after total hip arthroplasty (THA) is a proven risk factor for negative outcomes. Endoscopic or arthroscopic tenotomies of the iliopsoas offer a surgical solution with short-term results that have already been validated in prospective multicenter series. We carried out a review of the patients at more than 5 years of follow-up in order to assess the stability of the results over time. HYPOTHESIS Our main hypothesis was that endoscopic/arthroscopic tenotomies allow stable medium-term resolution of the painful symptoms of IPI. Our secondary hypothesis was that medium-term survival was satisfactory. MATERIAL AND METHOD This study is a continuation of a multicenter prospective series. Patients were contacted through multiple channels in order to: obtain an Oxford score, assess for satisfaction, psoas irritation, and daily pain on a visual analogue scale (VAS). RESULTS Of 64 patients in the original study, 57 were contacted. The Oxford score at the last follow-up was 40.7±7.7 [12-48]. There was a significant difference between the Oxford scores preoperatively, at 8 months and at the last follow-up. The mean satisfaction out of 10 was 8.0±2.1 [1-10]. We found 84% satisfaction at 5 years against 83% at 8 months. The VAS was 2.1±2.3 [0-10]. A straight leg psoas sign was present in 19.6% (10/51) of patients at 5 years, compared to 15.6% (8/51) at 8 months. The sign disappeared in four cases, while it reappeared during the interval in six cases. Survival was 91.2% (95% CI: 80.2-96.3) at 5 years. CONCLUSION Endoscopic/arthroscopic iliopsoas tenotomies represent a permanent medium-term solution to treat IPI after THA. The existence of a force differential or an acetabular overhang does not seem, within a certain limit, to impact the results in the medium term. LEVEL OF EVIDENCE IV; prospective series without control group.
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Affiliation(s)
- Pierre-Jean Lambrey
- Service de chirurgie orthopédique et traumatologique, CHU de Lille, 2, avenue Émile-Laine, 59000 Lille, France; Université Lille-Hauts de France, 59000 Lille, France.
| | - Nicolas Bonin
- Lyon Ortho Clinic, 29B, avenue des Sources, 69009 Lyon, France
| | - Mathieu Thaunat
- Centre orthopédique Santy, avenue Paul-Santy, 69008 Lyon, France
| | | | - Xavier Flecher
- Hôpital Nord, Assistance publique des hôpitaux de Marseille, 13000 Marseille, France
| | - Michael Wettstein
- ITOLS, clinique de Genolier, 3, route du Muids, 1272 Genolier, Switzerland
| | | | - Nicolas Prevot
- Clinique du sport, 4, rue Georges-Negrevergne, 33700 Merignac, France
| | - Olivier May
- Centre de chirurgie de la hanche, Médipole Garonne, 45, rue de Gironis, 31100 Toulouse, France
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Paraschos OA, Harris WT, Owens JS, Lall AC, Domb BG. Arthroscopic Peripheral Compartment Iliopsoas Release for Iliopsoas Impingement After Primary Total Hip Arthroplasty. Arthrosc Tech 2023; 12:e115-e120. [PMID: 36814974 PMCID: PMC9939739 DOI: 10.1016/j.eats.2022.08.066] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 08/28/2022] [Indexed: 01/24/2023] Open
Abstract
Anterior iliopsoas (IP) impingement after total hip arthroplasty is an underrecognized and continued cause for postoperative pain. There are multiple etiologies for this impingement from cup positioning and sizing to changes in the leg length, and offset must be evaluated to confirm no need for implant revision. Additionally, tension of the IP tendon can be increased in patients with diminished spinal mobility, either from prior fusion or with increasing age. Managing this surgically after failing conservative treatment options is best done arthroscopically to prevent additional large, open procedures that place the arthroplasty at unnecessary risk of infection and potential instability. In this article, we describe an arthroscopic technique using fluoroscopy to guide the release of the iliopsoas tendon from the peripheral compartment.
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Affiliation(s)
- Olivia A. Paraschos
- From the American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - W. Taylor Harris
- From the American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - Jade S. Owens
- From the American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - Ajay C. Lall
- From the American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
- American Hip Institute, Chicago, Illinois, U.S.A
| | - Benjamin G. Domb
- From the American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
- American Hip Institute, Chicago, Illinois, U.S.A
- Address correspondence to Dr. Benjamin G. Domb, 999 E. Touhy Ave., Suite 450, Des Plaines, IL, 60018, U.S.A.
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Carbonell-Rosell C, Soza D, Pujol O, de Albert de Delás-Vigo M, Antón A, Barro V. Iliopsoas impingement after total hip arthroplasty: Does the CT-scan have any role? Our Algorithm proposal. J Orthop 2022; 34:137-141. [PMID: 36072762 PMCID: PMC9441293 DOI: 10.1016/j.jor.2022.08.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 08/17/2022] [Accepted: 08/21/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction The first surgical option considered in managing iliopsoas impingement following THA is endoscopic/arthroscopic iliopsoas tenotomy, because of its low risk and minimal invasiveness. Acetabular revision is a much more aggressive surgery, recommended only in cases of substantial cup malposition. However, there are no clear indications for this procedure. The purpose of this article is to analyse the role of CT-scan measurement of acetabular cup positioning in a therapeutic algorithm for iliopsoas impingement. Methods In this retrospective observational study, we reviewed 25 patients treated for iliopsoas impingement following THA between 2011 and 2019. We studied acetabular cup positioning using CT-scan. We compared radiological parameters of patients who presented with significant clinical improvement with conservative treatment and with tenotomy against those who did not. Finally, we developed a proposed therapeutic algorithm. Results Forty-eight percent of patients presented a significant clinical improvement following conservative treatment. Patients who did not improve were found to have greater acetabular cup axial and sagittal overhang (p-values 0.016 and 0.003). These patients were considered for tenotomy. Of this group, those who did not improve with surgery (38%) showed greater axial overhang (p-value 0.005). Conclusions Conservative management should be the first line of treatment. In cases of non-operative treatment failure, axial acetabular cup overhang measured by CT-scan can be a useful tool in choosing between iliopsoas tenotomy or cup-revision surgery in selected cases of very severe acetabular malposition. A cut-off point of 10 mm of axial overhang is a reliable predictor of higher failure risk with iliopsoas tenotomy.
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Affiliation(s)
- Carla Carbonell-Rosell
- Hip Unit, Orthopaedic Surgery Department, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Diego Soza
- Hip Unit, Orthopaedic Surgery Department, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Oriol Pujol
- Hip Unit, Orthopaedic Surgery Department, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Alba Antón
- Radiology Department, Vall d’Hebron University Hospital, Barcelona, Spain
| | - Victor Barro
- Hip Unit, Orthopaedic Surgery Department, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
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Gebhardt S, Nonnenmacher L, Wassilew GI, Zimmerer A. Case Report: Intraarticular Iliopsoas Tendon causes Groin Pain Following Periacetabular Osteotomy. Front Surg 2022; 9:870993. [PMID: 35574527 PMCID: PMC9091960 DOI: 10.3389/fsurg.2022.870993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 03/22/2022] [Indexed: 11/13/2022] Open
Abstract
A 43-year-old female patient reported persistent iliopsoas-related groin pain following periacetabular osteotomy (PAO) combined with femoroplasty via a direct anterior approach due to CAM morphology. Concomitantly with the planned removal of screws, hip arthroscopy was performed, and the iliopsoas tendon was found to run intraarticularly, resulting in the tendon being impaired in its mobility and being entrapped. The tendon was arthroscopically released. The patient reported relief of the groin pain after the arthroscopic tendon debridement. During PAO combined with capsulotomy, the postoperatively observed intraarticular position of the iliopsoas tendon should be prevented by careful closure of the joint capsule.
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Conroy J, Caus S, Nelms NJ. A Case of Iliopsoas Bursitis With Compressive Femoral Nerve Palsy Treated With Iliopsoas Tendon Release. Arthroplast Today 2022; 14:148-153. [PMID: 35313716 PMCID: PMC8933726 DOI: 10.1016/j.artd.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 02/12/2022] [Accepted: 02/13/2022] [Indexed: 11/28/2022] Open
Abstract
Iliopsoas bursitis is a well-established cause of groin pain after total hip arthroplasty (THA), and it can become dramatically more complex when associated with neurovascular compression. Iliopsoas bursitis may be caused by a variety of pathologies in the setting of a THA but most frequently due to a prominent acetabular component or implant wear. Here we report a rare case of a female patient presenting with iliopsoas tendonitis, an accompanying femoral nerve palsy, and debilitating pain beginning 12 years after a previously successful primary THA without apparent implant wear. Ultimately, our patient was treated successfully with iliopsoas tendon release for anterior prominence of the acetabular component.
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