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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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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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Kobayashi K, Tsurumoto N, Tsuda S, Shiraishi K, Chiba K, Osaki M. The Anterior Position of the Hip Center of Rotation Is Related to Anterior Cup Protrusion Length and Symptomatic Iliopsoas Impingement in Primary Total Hip Arthroplasty. J Arthroplasty 2023; 38:2366-2372. [PMID: 37271227 DOI: 10.1016/j.arth.2023.05.047] [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: 02/10/2023] [Revised: 05/16/2023] [Accepted: 05/20/2023] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND Iliopsoas impingement (IPI) is an important complication after total hip arthroplasty (THA), and anterior cup protrusion is believed to be its main cause; however, the relationship between the hip center of rotation (COR) and symptomatic IPI or cup protrusion remains poorly understood. Therefore, the present study investigated these relationships. METHODS The medical records of 138 patients who underwent unilateral primary THA were retrospectively reviewed. There were 8 patients (5.8%) who had symptomatic IPI. The COR and cup protrusion length measured with 2 methods were assessed on computed tomography. Risk factors for symptomatic IPI and the relationship between the COR and protrusion length were evaluated. RESULTS Logistic regression analyses showed that anteroposterior position of the COR, sagittal cup protrusion length (SCPL) at the COR, and both axial and SCPLs at the most anterior margin of the cup were related to symptomatic IPI. Multivariable regression analyses showed that acetabular offset was related to axial protrusion length at the COR, and anteroposterior position of the COR was related to both axial and sagittal protrusion lengths at the most anterior margin of the cup. CONCLUSION Anterior position of the cup was related to symptomatic IPI and both axial and sagittal protrusion lengths at the most anterior margin of the cup. Anterior reaming and cup protrusion should be avoided as much as possible to prevent symptomatic IPI.
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Affiliation(s)
- Kyosuke Kobayashi
- Department of Orthopaedic Surgery, Nagasaki University Hospital, Nagasaki City, Nagasaki, Japan
| | - Naoji Tsurumoto
- Department of Orthopaedic Surgery, Nagasaki University Hospital, Nagasaki City, Nagasaki, Japan
| | - Soichiro Tsuda
- Department of Orthopaedic Surgery, Nagasaki University Hospital, Nagasaki City, Nagasaki, Japan
| | - Kazuteru Shiraishi
- Department of Orthopaedic Surgery, Nagasaki University Hospital, Nagasaki City, Nagasaki, Japan
| | - Ko Chiba
- Department of Orthopaedic Surgery, Nagasaki University Hospital, Nagasaki City, Nagasaki, Japan
| | - Makoto Osaki
- Department of Orthopaedic Surgery, Nagasaki University Hospital, Nagasaki City, Nagasaki, Japan
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Martinot P, Baujard A, Demondion X, Girard J, Migaud H. What happens in the medium-term to capsule-thickening plasties for iliopsoas impingement after total hip arthroplasty? Evaluation of 14 procedures at 4years' follow-up. Orthop Traumatol Surg Res 2023:103741. [PMID: 37923175 DOI: 10.1016/j.otsr.2023.103741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 06/04/2023] [Accepted: 09/07/2023] [Indexed: 11/07/2023]
Abstract
INTRODUCTION In 2015, we described a capsule-thickening technique via an anterior approach for iliopsoas cup impingement. To our knowledge, medium-term results have not been reported. We therefore retrospectively analyzed all cases in the initial series and those since 2015, to assess this original technique over a longer follow-up: (1) to analyze complications, and (2) to assess functional outcome. HYPOTHESIS The study hypothesis was that this surgical solution has a success rate sufficient for it to be included in the therapeutic armamentarium for iliopsoas impingement. MATERIAL AND METHOD Fourteen patients were included. Nine plasties were in first line, 3 after tenotomy, and 2 after cup exchange. The anterior Hueter approach was used, visualizing anterior cup overhang, sometimes associated with penetration of the anterior capsule, and enabling capsule-thickening by a folded Vicryl™ mesh. Functional results were analyzed. RESULTS At a median 4years' follow-up (IQR: 2-5; range: 1-9), change over baseline in Oxford score was 7 points (p=0.004), median Medical Research Council thigh flexion strength score was 5 (IQR: 5-5), and 50% of patients (7/14) were satisfied or very satisfied. The major complications rate was 7% (1/14), for 1 irrigation of infected hematoma, cured without recurrence; there was also 1 minor case of injury to the lateral cutaneous nerve of the thigh. Forty-three percent of patients (6/14) exhibited a minimal clinically important difference (MCID) and 64% (9/14) a patient-acceptable symptom state (PASS). Median anatomic overhang on anatomic CT transverse slice was 7mm (IQR: 3-8; range: 0-13). Four patients underwent secondary acetabular component exchange; their median overhang was 7.5mm (IQR: 7-8) compared to 5mm (IQR: 2-8) for the other patients (p-value non-calculable). CONCLUSION This surgical option seems interesting when acetabular overhang is not too great, especially as it does not affect flexion strength. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Pierre Martinot
- Département de Chirurgie Orthopédique, Groupement des Hôpitaux de l'Institut Catholique de Lille, Université Catholique de Lille, Lomme, France.
| | - Alexandre Baujard
- Service d'Orthopédie, Hôpital Salengro, CHU de Lille, place de Verdun, 59000 Lille, France
| | - Xavier Demondion
- Département d'Imagerie Musculosquelettique, Université de Lille, Centre de Consultations et d'Imagerie de l'Appareil Locomoteur (C.C.I.A.L.), CHU de Lille, rue du Professeur Émile-Laine, 59037 Lille cedex, France
| | - Julien Girard
- Service d'Orthopédie, Hôpital Salengro, CHU de Lille, place de Verdun, 59000 Lille, France; Université de Lille, CHU de Lille, ULR 2694 - METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, 59000 Lille, France; University of Lille, University of Artois, University Littoral Côte d'Opale, EA 7369 - Unité de Recherche Pluridisciplinaire Sport Santé Société (URePSS), 59000 Lille, France
| | - Henri Migaud
- Service d'Orthopédie, Hôpital Salengro, CHU de Lille, place de Verdun, 59000 Lille, France
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Bonano JC, Pierre K, Jamero C, Segovia NA, Huddleston JI, Safran MR. Endoscopic iliopsoas lengthening for treatment of recalcitrant iliopsoas tendinitis after total hip arthroplasty. J Hip Preserv Surg 2023; 10:63-68. [PMID: 37900893 PMCID: PMC10604048 DOI: 10.1093/jhps/hnac052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/14/2022] [Accepted: 03/02/2023] [Indexed: 10/31/2023] Open
Abstract
Iliopsoas (IP) tendinitis from impingement upon the acetabular component after total hip arthroplasty (THA) has been treated with open and endoscopic IP tenotomy or acetabular component revision. This study describes the results of a consecutive series of patients treated with endoscopic IP tenotomy as a less invasive alternative. Twenty-eight patients with IP impingement after THA underwent endoscopic IP lengthening from 2012 to 2021 at a single-center academic institution. The follow-up of 24 of these patients was achieved with a mean follow-up of 7.6 months (range 1-28). Outcomes included the modified Harris Hip Score (mHHS), visual analog pain scale (VAS), satisfaction, component positioning and complications. Seventy-one percent of patients were satisfied or very satisfied after their operation. The median mHHS preoperatively was 57 (Interquartile range [IQR] 43-60) and postoperatively was 75 (IQR 66-92, P < 0.001). Clinically meaningful improvements in mHHS were seen in patients with VAS pain scores <5, cup prominence >8 mm, body mass index >30, and less than 2 years from their index THA. Two patients developed a deep infection 7 and 10 months postoperatively (neither related to the release), and one patient underwent open psoas release for persistent impingement. Endoscopic IP tenotomy is a safe and effective treatment for impingement after THA. Patients with cup prominence >8 mm, body mass index >30 and less than 2 years since their index THA may have more clinically meaningful improvements in pain and function.
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Affiliation(s)
- John C Bonano
- Department of Orthopaedic Surgery, Stanford Hospitals and Clinics, 450 Broadway Street, Redwood City, CA 94063, USA
| | - Kinsley Pierre
- Department of Orthopaedic Surgery, Stanford Hospitals and Clinics, 450 Broadway Street, Redwood City, CA 94063, USA
| | - Christopher Jamero
- Department of Orthopaedic Surgery, Stanford Hospitals and Clinics, 450 Broadway Street, Redwood City, CA 94063, USA
| | - Nicole A Segovia
- Department of Orthopaedic Surgery, Stanford Hospitals and Clinics, 450 Broadway Street, Redwood City, CA 94063, USA
| | - James I Huddleston
- Department of Orthopaedic Surgery, Stanford Hospitals and Clinics, 450 Broadway Street, Redwood City, CA 94063, USA
| | - Marc R Safran
- Department of Orthopaedic Surgery, Stanford Hospitals and Clinics, 450 Broadway Street, Redwood City, CA 94063, USA
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Is there any clinical advantage of capsular repair over capsular resection for total hip arthroplasty? An updated systematic review and meta-analysis. Arch Orthop Trauma Surg 2023; 143:1689-1697. [PMID: 35523972 DOI: 10.1007/s00402-022-04444-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 04/10/2022] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Although several surgical approaches, with or without capsular repair, can be used during total hip arthroplasty (THA), there is no clear evidence that capsular repair provides a clinical advantage post-surgery, regardless of surgical approach. This systematic review and meta-analysis evaluated whether capsular repair using various surgical approaches provides a clinical advantage over capsular resection post-THA. METHODS This study was conducted in accordance with the preferred reporting items for systematic reviews and meta-analyses (PRISMA) 2020 checklist for systematic reviews and meta-analyses. Multiple comprehensive literature searches were performed. Results were summarized qualitatively as meta-analysis of pooled odds ratios, and the standardized mean difference, with 95% confidence intervals for each group: capsular repair or capsular resection. A P value < 0.05 was considered statistically significant. Each study was evaluated for the risk of bias. Publication bias was also assessed. RESULTS A total of 12 studies were included after screening and eligibility assessment. The odds ratio for hip dislocation after capsular repair was 0.14 (P < 0.00001). The standard mean difference of the Harris Hip Score (HHS) after capsular repair was 1.11 (P = 0.02). There were no significant differences between groups with respect to operation time (P = 0.79) and blood loss (P = 0.42). CONCLUSION The current meta-analysis suggests that capsular repair leads to lower dislocation rates and a better HHS after THA.
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Park CW, Yoo I, Cho K, Jeong SJ, Lim SJ, Park YS. Incidence and Risk Factors of Iliopsoas Tendinopathy After Total Hip Arthroplasty: A Radiographic Analysis of 1,602 Hips. J Arthroplasty 2023:S0883-5403(23)00056-6. [PMID: 36720417 DOI: 10.1016/j.arth.2023.01.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 01/21/2023] [Accepted: 01/23/2023] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Iliopsoas tendinopathy (IPT) can cause persistent groin pain and lead to dissatisfaction after total hip arthroplasty (THA). This study aimed to report the characteristics, incidences, risk factors, and treatment outcomes of IPT after THA. METHODS We reviewed primary THAs performed at a single institution between January 2012 and May 2018. Clinical and radiographic analyses were performed on 1,602 THAs (1,370 patients). Patient characteristics, component sizes, inclination and anteversion angles, and antero-inferior cup prominence (≥8 millimeters (mm)), were compared between the groups with and without IPT. Changes in teardrop to lesser trochanter distance were measured to estimate changes in leg length and horizontal offset caused by THA. Logistic regression models were used to identify the risk factors for IPT. IPT was identified in 53 hips (3.3%). RESULTS Patients with IPT had greater leg lengthening (12.3 versus 9.3 mm; P = .001) and higher prevalence of antero-inferior cup prominence (5.7 versus 0.4%; P = .002). There was no significant difference in inclination, anteversion, and horizontal offset change between the two groups. In multivariate analyses, greater leg lengthening, prominent acetabular cup, women, and higher body mass index were associated with IPT. All patients reported improvement in groin pain after arthroscopic tenotomy, while 35.7% with nonoperative management reported improvement (P < .001). CONCLUSIONS Symptomatic IPT occurred in 53 (3.3%) of the 1,602 primary THAs. Our findings suggest that leg lengthening as well as prominent acetabular cup in THAs can be associated with the development of IPT. Arthroscopic tenotomy was effective in relieving groin pain caused by IPT.
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Affiliation(s)
- Chan-Woo Park
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Insun Yoo
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Kyungjun Cho
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sang-Jin Jeong
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Seung-Jae Lim
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Youn-Soo Park
- Department of Orthopedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Nikou S, Lindman I, Sigurdsson A, Karlsson L, Öhlin A, Senorski EH, Sansone M. Arthroscopic iliopsoas tenotomy after total hip arthroplasty: safe method for the right patient. J Exp Orthop 2023; 10:3. [PMID: 36652032 PMCID: PMC9849514 DOI: 10.1186/s40634-023-00568-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 01/11/2023] [Indexed: 01/19/2023] Open
Abstract
PURPOSE To evaluate the outcome of arthroscopic treatment for iliopsoas impingement after total hip arthroplasty (THA) 2 years after surgery using patient reported outcomes (PROM). METHODS In this study 12 patients (13 hips) were included from a local hip arthroscopy registry. Patients completed web-based PROMs preoperatively and at a minimum of 2 years postoperatively. The PROMs included the International Hip Outcome Tool short version (iHOT-12), the Copenhagen Hip and Groin Outcome Score (HAGOS), the European Quality of Life-5 Dimensions Questionnaire (EQ-5D), the Hip Sports Activity Scale (HSAS) for physical activity level, the Visual Analog Scale (VAS) for overall hip function and a single question regarding overall satisfaction with the surgery. RESULTS The mean age was 64.4 years (±15.1SD), mean body mass index (BMI) was 26.6 (±4.3SD), mean follow-up time was 49.8 months (±25SD). Comparing PROMs preoperatively with 2-year follow up showed an improvement for many of the PROMs used. The PROMs scores were iHOT-12 (24.9 vs 34.5, p = 0.13), HAGOS subscales (symptoms 38.2 vs 54.5, p = 0.05; pain 36 vs 53, p = 0.04; sport 14.1 vs 35.1, p = 0.03; daily activity 31 vs 47.5, p = 0.04; physical activity 21.8 vs 24, p = 0.76; quality of life 24 vs 35, p = 0.03), EQ-VAS (57.9 vs 58, p = 0.08), EQ-5D (0.34 vs 0.13, p = 0.07) and VAS for overall hip function (43.1 vs 46.2, p = 0.14). In total, 10 out of the 12 patients (83%) were satisfied with the intervention. CONCLUSION Patients undergoing surgery for iliopsoas impingement after previous THA showed improved self-reported hip function where most patients were satisfied with treatment.
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Affiliation(s)
- Sarantos Nikou
- grid.8761.80000 0000 9919 9582Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden ,Department of Orthopaedic Surgery, South Älvsborg Hospital, 501 82 Borås, Sweden
| | - Ida Lindman
- grid.8761.80000 0000 9919 9582Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Arnar Sigurdsson
- grid.8761.80000 0000 9919 9582Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Louise Karlsson
- grid.8761.80000 0000 9919 9582Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Axel Öhlin
- grid.8761.80000 0000 9919 9582Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Eric Hamrin Senorski
- grid.8761.80000 0000 9919 9582Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Mikael Sansone
- grid.8761.80000 0000 9919 9582Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Deckard ER, Meneghini RM. Diagnosis and Treatment of Musculotendinous Deficiencies of the Hip. J Arthroplasty 2022; 37:1501-1504. [PMID: 35283237 DOI: 10.1016/j.arth.2022.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 01/11/2022] [Accepted: 03/04/2022] [Indexed: 02/02/2023] Open
Abstract
Musculotendinous deficiencies related to iliopsoas tendinitis and abductor mechanism disruption following total hip arthroplasty (THA) are frequently under diagnosed and can be frustrating to surgeons and devastating to patients with painful THAs with normal appearing radiographs. Current peer-reviewed evidence is presented for diagnosis and treatment options for these two musculotendinous deficiencies. While these musculotendinous deficiencies are treatable, prevention during the primary THA is ideal, and special attention should be taken into consideration for optimized acetabular cup size and position, optimized hip biomechanics, and preservation and protection of the abductor tendon insertion to the greater trochanter.
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Affiliation(s)
- Evan R Deckard
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - R Michael Meneghini
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN
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Blackman A. Editorial Commentary: Iliopsoas Tenotomy for Pain After Total Hip: A Great Operation IF the Diagnosis Is Right. Arthroscopy 2021; 37:2830-2831. [PMID: 34481623 DOI: 10.1016/j.arthro.2021.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 05/01/2021] [Indexed: 02/02/2023]
Abstract
Iliopsoas tendon pain can be a frustrating condition for both patients and surgeons after total hip arthroplasty. It is difficult to diagnose definitively, as there is no imaging modality that offers reliable information and there are numerous causes of persistent groin pain in this patient population. The pain can ruin the results of an otherwise well-functioning total hip arthroplasty. Patients who respond best to arthroscopic iliopsoas tenotomy are those with isolated pain with hip flexion activities and reproducible pain with resisted hip flexion on examination or other provocative iliopsoas maneuvers. Patients with these symptoms in addition to more generalized pain findings (pain with weight-bearing, pain at night, pain with passive range of motion) tend not to respond as favorably to isolated iliopsoas tenotomy. In addition, optimal treatment for refractory cases has been controversial historically, as both acetabular component revision and iliopsoas tendon lengthening have been advocated. With the ever-increasing popularity of hip arthroscopy and recent clinical outcome reports, arthroscopic (or endoscopic) iliopsoas tenotomy has proven to be a very safe and effective treatment option for these patients, with one caveat: the diagnosis must be correct.
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Viamont-Guerra MR, Ramos-Pascual S, Saffarini M, Bonin N. Endoscopic Tenotomy for Iliopsoas Tendinopathy Following Total Hip Arthroplasty Can Relieve Pain Regardless of Acetabular Cup Overhang or Anteversion. Arthroscopy 2021; 37:2820-2829. [PMID: 33812032 DOI: 10.1016/j.arthro.2021.03.043] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 03/19/2021] [Accepted: 03/21/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To report outcomes of endoscopic iliopsoas tenotomy (EIT) in patients with iliopsoas tendinopathy following total hip arthroplasty (THA) and determine whether improvements in clinical scores are associated with acetabular cup anteversion measured on plain radiographs or overhang measured using established and alternative computed tomography (CT)-based methods. METHODS We evaluated patients who underwent EIT for iliopsoas tendinopathy after THA (2014-2017), performed between the lesser trochanter and psoas valley. Indications were groin pain during active hip flexion, exclusion of other complications, and no pain relief after 6 months of conservative treatment. Pretenotomy inclination and anteversion were measured on radiographs; sagittal and axial overhang were measured on CT scans on slices passing through: (Method 1) prosthetic head center and (Method 2) anterior margin of acetabular cup. Modified Harris hip score (mHHS), Oxford Hip Score (OHS), and level of groin pain were recorded at 12 or more months. Wilcoxon signed-rank tests were used to compare pre- and post-tenotomy scores, and intraclass correlation coefficients (ICCs) to assess intermethod agreement. RESULTS The cohort comprised 16 men (17 hips) and 32 women (33 hips), aged 60.8 ± 10.5 years at EIT. For the 30 (60%) hips that had pretenotomy CT scans, axial and sagittal overhang were, respectively, 3.4 ± 3.7 mm and 4.6 ± 4.6 mm, using Method 1, compared with 3.9 ± 3.9 mm and 6.9 ± 5.0 mm using Method 2. Intermethod agreement was good for axial (ICC, 0.67; P < .001) and sagittal (ICC, 0.68; P < .001) overhang. At a minimum 1 year after EIT, 3 hips had cup and stem revision and 1 hip had isolated cup revision, leaving 46 hips for clinical assessment. No complications were noted. mHHS improved by 26 ± 19 (P < .001) and OHS improved by 20 ± 11 (P < .001). Twenty-six hips (57%) achieved the patient acceptable symptom state for mHHS, whereas 42 hips (91%) achieved the patient acceptable symptom state for OHS. Post-tenotomy groin pain was slight in 15%, mild in 17%, and moderate in 11%. Regression analyses revealed no associations between clinical scores and overhang/anteversion. CONCLUSIONS For patients with iliopsoas tendinopathy following THA, endoscopic iliopsoas tenotomy granted clinically important improvements of mHHS in 76% and OHS in 89%, despite moderate residual groin pain in 11%. Improvements in clinical scores did not seem to be associated with the extent of cup overhang or anteversion in the cases for which adequate preoperative imaging was available. LEVEL OF EVIDENCE Level IV, retrospective cohort study.
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Affiliation(s)
- Maria-Roxana Viamont-Guerra
- Hip Surgery Unit, Hospital Israelita Albert Einstein, São Paulo - SP, Brazil; Lyon Ortho Clinic, Lyon, France
| | | | | | - Nicolas Bonin
- Hip Surgery Unit, Hospital Israelita Albert Einstein, São Paulo - SP, Brazil; Lyon Ortho Clinic, Lyon, France
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Yun A, Qutami M, Pasko KB. Surgical Management of Iliopsoas Impingement With Combined Acetabular Revision and Partial Psoas Tenotomy. Cureus 2021; 13:e13193. [PMID: 33717735 PMCID: PMC7943055 DOI: 10.7759/cureus.13193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Persistent 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. Methodology A 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. Results Of 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). Conclusion IPI 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.
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Affiliation(s)
- Andrew Yun
- Orthopaedic Surgery, Center for Hip and Knee Replacement, Providence Saint John's Health Center, Santa Monica, USA
| | - Marilena Qutami
- Orthopaedic Surgery, Center for Hip and Knee Replacement, Providence Saint John's Health Center, Santa Monica, USA
| | - Kory B Pasko
- Orthopaedic Surgery, Georgetown University School of Medicine, Georgetown Hospital, Washington, DC, USA
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Pozzi L, Lehnen A, Kalberer F, Meier C, Wahl P. Reconstruction of the Anterior Acetabular Wall to Repair Symptomatic Defects Consecutive to Cup Malpositioning at Total Hip Arthroplasty. Arthroplast Today 2020; 7:260-263.e0. [PMID: 33786351 PMCID: PMC7987933 DOI: 10.1016/j.artd.2020.11.015] [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: 09/03/2020] [Revised: 11/08/2020] [Accepted: 11/21/2020] [Indexed: 11/28/2022] Open
Abstract
Iliopsoas impingement (IPI) causes persistent groin pain and functional impairment after total hip arthroplasty (THA). It is caused most often by an overhang of the cup. Psoas tenotomy may successfully treat IPI in overhangs <8 mm. Cup revision usually is recommended for larger overhangs. Muscle sparing reconstruction of the anterior acetabular wall may be an alternative when malposition of the cup at THA caused a bony defect that would persist after simple cup revision. The surgical technique and results from one patient are presented. The patient rapidly became asymptomatic and remained pain free at 2-year follow-up. Any bone substance defect of the acetabulum should be considered when evaluating treatment options for IPI after THA.
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Affiliation(s)
- Lara Pozzi
- Division of Orthopaedics and Traumatology, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Aude Lehnen
- Division of Orthopaedics and Traumatology, Cantonal Hospital Winterthur, Winterthur, Switzerland.,Department of Surgery, Hospital Centre Biel, Biel, Switzerland
| | - Fabian Kalberer
- Division of Orthopaedics and Traumatology, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Christoph Meier
- Division of Orthopaedics and Traumatology, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Peter Wahl
- Division of Orthopaedics and Traumatology, Cantonal Hospital Winterthur, Winterthur, Switzerland
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