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Chen H, Lai P, Lu H, Zhu J, Sang W, Wang C, Zhong Y, Zhu L, Ma J. Groin pain aggravated in short term contracted by COVID-19 in THA patients: a case-crossover study. J Orthop Surg Res 2024; 19:374. [PMID: 38915048 PMCID: PMC11194934 DOI: 10.1186/s13018-024-04862-1] [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: 04/17/2024] [Accepted: 06/17/2024] [Indexed: 06/26/2024] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) rapidly spreads worldwide and causes more suffering. The relation about the aggravation of inguinal pain and COVID-19 was unclear in patients with total hip arthroplasty (THA). This study aimed to evaluate the risk of groin pain aggravation in short-term THA patients after COVID-19. METHODS Between 2020 and 2022, 129 patients with THA who were affected COVID-19 were enrolled. A short-standardized questionnaire was administered during follow-up to inquire about the aggravation of groin ache before and after SARS-COV-2 affection. Furthermore, we evaluated the potential association between the presence of increased pain and various factors, including age, gender, body mass index, diagnosis, and length of hospital stay. RESULTS The case-crossover study revealed an increased risk of inguinal soreness aggravation when comparing 8 weeks after COVID-19 with 12 weeks before COVID-19 (Relative risk [RR], 9.5; 95% Confidence intervals [CI], 2.259-39.954). For COVID-19 positive patients, multivariate analysis showed length of stay was an independent factor significantly associated with increased risk of aggravation of groin pain (Odds ratio [OR], 1.26; 95%CI, 1.03-1.55, p = 0.027). CONCLUSION This study confirms the association between COVID-19 and the exacerbation of soreness in the groin region in THA patients and extended length of stay is a possible contributing factor. This study expands the current literature by investigating the risk of aggravation of inguinal pain in patients with THA after COVID-19, providing valuable insights into postoperative outcomes in this specific population. Trial registration This retrospective study was approved by the Institutional Review Board of Shanghai general hospital (No.2023-264).
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Affiliation(s)
- Hongjie Chen
- Department of Orthopedics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China
| | - Peng Lai
- Department of Orthopedics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China
| | - Haiming Lu
- Department of Orthopedics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China
| | - Jun Zhu
- Department of Neurosurgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 201620, China
| | - Weilin Sang
- Department of Orthopedics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China
| | - Cong Wang
- Department of Orthopedics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China
| | - Yiming Zhong
- Department of Orthopedics, Peking University Third Hospital, Beijing, 100191, China
| | - Libo Zhu
- Department of Orthopedics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China.
| | - Jinzhong Ma
- Department of Orthopedics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China.
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Albano D, Pansa S, Messina C, Gitto S, Serpi F, Fusco S, Midiri F, Zagra L, Sconfienza LM. MRI of total hip arthroplasty: technical aspects and imaging findings. Insights Imaging 2024; 15:152. [PMID: 38900339 PMCID: PMC11189891 DOI: 10.1186/s13244-024-01717-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 05/08/2024] [Indexed: 06/21/2024] Open
Abstract
Total hip arthroplasty (THA) is the best surgical approach for treating advanced hip degeneration, providing pain relief, and improved function in most cases. In the past, MR imaging quality has been highly compromised by in-plane distortions, inadequate fat saturation, and other artifacts due to metal components of THA. Technological advancements have made pathologic conditions, which were previously hidden by periprosthetic artifacts, outstanding features due to the optimization of several sequences. To date, several short and long-term complications involving bony and soft-tissue structures may be detected through magnetic resonance imaging (MRI). The use of MRI with adapted sequences and protocols may drastically reduce artifacts thereby providing essential pre-operative elements for planning revision surgery of failed THA. This review has the purpose of conveying new insights to musculoskeletal radiologists about the techniques to suppress metal-related artifacts and the hallmark MRI findings of painful THA. CRITICAL RELEVANCE STATEMENT: Advancements in metal-suppression have given radiologists the opportunity to play an emerging role in THA management. This article provides technical and imaging insights into challenges that can be encountered in cases of THA, which may present complications and characteristic imaging findings. KEY POINTS: Imaging total hip arthroplasty requires adapted MRI protocol and awareness of the common complications. We have reported the available metal-suppression sequences for evaluating total hip arthroplasty. Many structures and conditions should be considered when dealing with painful aseptic or septic arthroplasty.
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Affiliation(s)
- Domenico Albano
- IRCCS Istituto Ortopedico Galeazzi, Milano, Italy.
- Dipartimento di Scienze Biomediche, Chirurgiche ed Odontoiatriche, Università degli Studi di Milano, Milano, Italy.
| | - Simone Pansa
- Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Milano, Italy
| | - Carmelo Messina
- IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università Degli Studi di Milano, Milano, Italy
| | - Salvatore Gitto
- IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università Degli Studi di Milano, Milano, Italy
| | - Francesca Serpi
- IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università Degli Studi di Milano, Milano, Italy
| | - Stefano Fusco
- IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università Degli Studi di Milano, Milano, Italy
| | | | - Luigi Zagra
- IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
| | - Luca Maria Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università Degli Studi di Milano, Milano, Italy
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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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5
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Waters GC, Jones C, D'Alessandro P, Yates P. Functional assessment of component positioning in patients with groin pain after total hip arthroplasty as a tool to guide management. Hip Int 2024; 34:336-343. [PMID: 37861204 DOI: 10.1177/11207000231205843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
BACKGROUND Persisting groin pain post total hip arthroplasty (THA) is a common and complex issue that can be difficult to diagnose and manage. Acetabular component positioning is often implicated. AIMS AND METHODS We used a previously well described and validated functional positioning protocol to determine if functional acetabular malpositioning was a factor in groin pain post THA and hence to determine if acetabular revision would be indicated. We compared patient-specific functional acetabular positioning to traditional CT evaluation of cup position and assessment of anterior cup overhang. RESULTS 39 patients with groin pain post-THA were investigated. Functional acetabular malpositioning was diagnosed in 31% (12/39). Revision THA was performed in those 12 patients, resulting in resolution of functional malpositioning (100%), with an overall accuracy of 5.6° (range 1-12), and resolution of groin pain in 67% (8/12). 33% (4/12) of the revised implants had functional positioning located outside the traditional "40/20 zone". Comparison with CT indicated that 40% (4/10) of implants with anterior overhang were well positioned, however only 50% (6/12) of functionally malpositioned implants had CT evidence of anterior cup prominence. Of the 8/12 revision patients who had resolution of their groin pain, only 1 had cup prominence. CONCLUSIONS This study suggests that the utilisation of a patient specific functional positioning algorithm in the analysis of persistent groin pain following THA can assist in identifying the underlying cause of pain and help to guide treatment. For a functionally malpositioned acetabulum, revision surgery offers a potential resolution of groin pain.
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Affiliation(s)
| | | | | | - Piers Yates
- University of Western Australia, Fremantle Hospital and Health Service, Perth, WA, Australia
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Hardwick-Morris M, Twiggs J, Miles B, Al-Dirini RMA, Taylor M, Balakumar J, Walter WL. Determination of preoperative risk factors for iliopsoas tendonitis after total hip arthroplasty: A simulation study. J Orthop Res 2024. [PMID: 38587991 DOI: 10.1002/jor.25856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 02/28/2024] [Accepted: 03/30/2024] [Indexed: 04/10/2024]
Abstract
This study aims to identify preoperative risk factors for iliopsoas tendonitis after total hip arthroplasty, a complication typically attributed to acetabular cup position and orientation, using a validated iliopsoas impingement detection simulation. Analyzing CT scans and X-rays of 448 patients using a validated preoperative planning protocol, patients were simulated for iliopsoas impingement and categorized into at-risk and not at-risk groups based on a prior validation study, with a 23% at-risk incidence. Implementing a propensity score matching algorithm to reduce covariate imbalance, we identified factors that may exacerbate risk of iliopsoas tendonitis. Parameters that were investigated included standing pelvic tilt, functional femoral rotation, and the difference between the planned acetabular cup diameter and native femoral head diameter (ΔC-NFH). Comparing pelvic tilt, we found a significant difference between the groups (at-risk: -6.0°, not at-risk: -0.7°; p << 0.01). A similar trend was noted for ΔC-NFH (at-risk: +5.7 mm, not at-risk: +5.1 mm; p = 0.01). Additional simulations of at-risk patients indicated increased anteversion of the acetabular cup reduces impingement risk more effectively than medialisation. These findings suggest that spinopelvic parameters may exacerbate iliopsoas irritation risk, underscoring their importance in preoperative planning and patient expectation management. Similar findings of a greater than 6 mm difference between cup size and native femoral head diameter being a significant risk for iliopsoas tendonitis have been observed before, underscoring its potential veracity. These results may provide surgeons with a simple threshold that can be used in determining a cup size to reduce the risk of iliopsoas tendonitis.
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Affiliation(s)
- Max Hardwick-Morris
- 360 Med Care, Sydney, New South Wales, Australia
- Enovis, Sydney, New South Wales, Australia
- College of Science and Engineering, Flinders University, Adelaide, South Australia, Australia
| | - Joshua Twiggs
- 360 Med Care, Sydney, New South Wales, Australia
- Enovis, Sydney, New South Wales, Australia
| | - Brad Miles
- 360 Med Care, Sydney, New South Wales, Australia
- Enovis, Sydney, New South Wales, Australia
| | - Rami M A Al-Dirini
- College of Science and Engineering, Flinders University, Adelaide, South Australia, Australia
| | - Mark Taylor
- College of Science and Engineering, Flinders University, Adelaide, South Australia, Australia
| | | | - William L Walter
- Institute of Bone and Joint Research, Kolling Institute, The University of Sydney, Sydney, New South Wales, Australia
- Department of Orthopaedics and Traumatic Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
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7
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Hardwick-Morris M, Twiggs J, Miles B, Al-Dirini RMA, Taylor M, Balakumar J, Walter WL. Comparison of iliopsoas tendonitis after hip resurfacing arthroplasty and total hip arthroplasty: A case-controlled investigation using a validated simulation. J Orthop Res 2024. [PMID: 38366978 DOI: 10.1002/jor.25815] [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: 11/27/2023] [Revised: 01/24/2024] [Accepted: 02/02/2024] [Indexed: 02/19/2024]
Abstract
Iliopsoas tendonitis, typically caused by impingement with the acetabular cup, occurs in up to 18% of patients after total hip arthroplasty (THA) and up to 30% of patients after hip resurfacing arthroplasty (HRA). We have developed a simulation for detecting iliopsoas impingement and validated it in a previous study of THA patients. However, due to the difference in incidence between HRA and THA, this study had two aims. First, to validate the simulation in a cohort of HRA patients and, second, to comparethe results of the HRA and THA patients to understand any differences in their etiology. We conducted a retrospective search in an experienced surgeon's database for HRA patients with iliopsoas tendonitisand control patients without iliopsoas tendonitis, resulting in two cohorts of 12 patients. Using CT scans, 3D models of the each patient's prosthetic and bony anatomy were generated, landmarked, and simulated. Regarding validation of the simulation for HRA patients, impingement significantly predicted the probability of iliopsoas tendonitis in logistic regression models and the simulation had a sensitivity of 83%, specificity of 100%, and an AUC ROC curve of 0.95. Unexpectedly, the HRA cohort exhibited less impingement than the THA cohort. Our novel simulation has now been demonstrated to detect iliopsoas impingement and differentiate between the symptomatic and asymptomatic cohorts in investigations of THA and HRA patients. This tool has the potential to be used preoperatively, to guide decisions about optimal cup placement, and postoperatively, to assist in the diagnosis of iliopsoas tendonitis.
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Affiliation(s)
- Max Hardwick-Morris
- 360 Med Care, Sydney, Australia
- Enovis ANZ, Sydney, Australia
- College of Science and Engineering, Flinders University, Adelaide, Australia
| | - Joshua Twiggs
- 360 Med Care, Sydney, Australia
- Enovis ANZ, Sydney, Australia
| | - Brad Miles
- 360 Med Care, Sydney, Australia
- Enovis ANZ, Sydney, Australia
| | - Rami M A Al-Dirini
- College of Science and Engineering, Flinders University, Adelaide, Australia
| | - Mark Taylor
- College of Science and Engineering, Flinders University, Adelaide, Australia
| | | | - William L Walter
- Institute of Bone and Joint Research, Kolling Institute, The University of Sydney, Sydney, Australia
- Department of Orthopaedics and Traumatic Surgery, Royal North Shore Hospital, Sydney, Australia
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English RT, Munro JT, Monk AP. Increasing femoral head size from 32 mm to 36 mm does not increase the revision risk for total hip replacement: a New Zealand joint registry study. Hip Int 2024; 34:66-73. [PMID: 37932243 DOI: 10.1177/11207000231210487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
BACKGROUND The use of larger femoral heads in total hip replacement (THR) has increased over the last decade. While the relationship between increasing head size and increased stability is well known, the risk of revision with increasing head size remains poorly understood. The aim of this study was to compare the outcome of total hip joint replacement with 32-mm and 36-mm heads. METHODS We carried out a 20-year retrospective analysis of prospective data from the New Zealand Joint Registry (NZJR). All primary total hip replacements registered between January 1999 and December 2018 were included. We compared the rate of revision of 32-mm and 36-mm heads in THR. Sub-group analysis included comparisons of bearing type and all-cause revision. RESULTS 60,051 primary THRs met our inclusion criteria. The revision rate per 100 component years was significantly higher with a 36-mm head than with a 32-mm head (0.649 vs. 0.534, p < 0.001). Subgroup analysis of bearing type showed no significant differences in revision rates for all combinations of 36-mm heads when compared to 32-mm (p = 0.074-0.92), with the exception of metal-on-metal (MoM); p = 0.038. When MoM was removed there was no significant difference in revision rates per 100 component years between 32-mm and 36-mm heads, 0.528 versus 0.578 (p = 0.099). CONCLUSIONS Increasing head size from 32 mm to 36 mm results in no significant increase in revision in all bearing combinations except MoM.
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Affiliation(s)
- Robert Tr English
- Department of Orthopaedic Surgery, Auckland City Hospital, Auckland, New Zealand
| | - Jacob T Munro
- Department of Orthopaedic Surgery, Auckland City Hospital, Auckland, New Zealand
- University of Auckland, New Zealand
| | - Andrew P Monk
- Department of Orthopaedic Surgery, Auckland City Hospital, Auckland, New Zealand
- University of Auckland, New Zealand
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Weintraub MT, Barrack TN, Burnett RA, Serino J, Bhanot SS, Della Valle CJ. Ultrasound-Guided Iliopsoas Bursal Injections for Management of Iliopsoas Bursitis After Total Hip Arthroplasty. J Arthroplasty 2023; 38:S426-S430. [PMID: 36535438 DOI: 10.1016/j.arth.2022.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 12/08/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Iliopsoas tendonitis can cause persistent pain after total hip arthroplasty (THA). Nonoperative management of iliopsoas tendonitis includes anti-inflammatory drugs and image-guided corticosteroid injections. This study evaluated the efficacy of ultrasound-guided corticosteroid injections (US-CSIs) for iliopsoas tendonitis following THA. METHODS We retrospectively reviewed 42 patients who received an US-CSI for iliopsoas tendonitis after primary THA between 2009 and 2020 at a single institution. Outcomes including reoperation, groin pain at last follow-up, additional intrabursal injection, and Harris Hip Score (HHS) were evaluated at a minimum of 1 year. Cross-table lateral radiographs (36 patients) or computed tomography scans (6 patients) were reviewed to determine if anterior cup overhang was present, indicating a mechanical etiology of iliopsoas tendonitis. Descriptive statistics and univariate comparison of HHS preinjection and postinjection were performed, with alpha < 0.05. RESULTS Among the 22 patients who did not have cup overhang, four (18.2%) had persistent groin pain at mean follow-up of 40 months (range, 14-94) after US-CSI. Three patients had a second injection; none had groin pain at most recent follow-up. No patients required acetabular revision. Mean HHS improved from 74 points (range, 52-94 points) to 91 points (range, 76-100 points; P < .001) at last follow-up. Among the 20 patients who had anterior cup overhang, five underwent acetabular revision after only temporary pain relief from injection. Groin pain was resolved in all revised patients at mean follow-up of 43 months (range, 12-60) after revision. Of the remaining 15 patients, five had persistent groin pain at mean follow-up of 35 months (range, 12-83). Mean HHS improved from 69 points (range, 50-96 points) preinjection to 81 (range, 56-98 points; P = .007) at last follow-up. CONCLUSION Resolution of groin pain was demonstrated in 78.6% of patients in the cohort; however, those who did not have acetabular overhang had higher rates of success. The overall revision rate was 11.9%. US-CSI appears to be safe and effective in the diagnosis and treatment of iliopsoas tendonitis following primary THA. LEVEL OF EVIDENCE Level IV, Therapeutic Study.
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Affiliation(s)
- Matthew T Weintraub
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Toby N Barrack
- Washington University in St. Louis Medical School, St. Louis, Missouri
| | - Robert A Burnett
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Joseph Serino
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Shelly S Bhanot
- Department of Interventional Radiology, Rush University Medical Center, Chicago, Illinois
| | - Craig J Della Valle
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
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10
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Zhang B, Li W, Li M, Ding X, Huo J, Wu T, Han Y. The role of 3-dimensional preoperative planning for primary total hip arthroplasty based on artificial intelligence technology to different surgeons: A retrospective cohort study. Medicine (Baltimore) 2023; 102:e34113. [PMID: 37352023 PMCID: PMC10289585 DOI: 10.1097/md.0000000000034113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 04/04/2023] [Accepted: 06/05/2023] [Indexed: 06/25/2023] Open
Abstract
Preoperative planning with computed tomography (CT)-based 3-dimensiona (3D) templating has been achieved precise placement of hip components. This study investigated the role of the software (3-dimensional preoperative planning for primary total hip arthroplasty [THA] based on artificial intelligence technology, artificial intelligence hip [AIHIP]) for surgeons with different experience levels in primary THA. In this retrospective cohort study, we included patients, who had undergone THA with the help of the AIHIP, and matched to patients, who had undergone THA without the help of the AIHIP, by age and the doctor who operated on them. The subjects were divided into 4 groups, senior surgeon (Chief of Surgery) with AIHIP group, senior surgeon without AIHIP group, junior surgeon (Associate Chief of Surgery) with AIHIP group and junior surgeon without AIHIP group. The general data, imaging index, clinical outcomes and accuracy of stem size prediction and cup size prediction were retrospectively documented for all patients. There was a significant difference in discrepancy in leg length (P = .010), neck-shaft angle (P = .025) and femoral offset (P = .031) between the healthy side and the affected side, operation duration (P < .001), decrease in hemoglobin (Hb) per 24 hours (P = .046), intraoperative radiation exposure frequency (P < .050) and postoperative complications (overall P = .035) among the patients in junior surgeon group. No significant differences were found between senior surgeon groups with respect to discrepancy in leg length (P = .793), neck-shaft angle (P = .088)and femoral offset (P = .946) between the healthy side and the affected side, operation duration (P = .085), decrease in Hb per 24 hours (P = .952), intraoperative radiation exposure frequency (P = .094) and postoperative complications (overall P = .378). The stem sizes of 95% were accurately estimated to be within 1 stem size, and 97% of the cup size estimates were accurate to within 1 cup size in senior surgeon group with AIHIP. A total of 87% stem sizes were accurately estimated to be within 1 stem size, and 85% cup sizes were accurate to within 1 cup size in junior surgeon group with AIHIP. In conclusion, our study suggests that an AI-based preoperative 3D planning system for THA is a valuable adjunctive tool for junior doctor and should routinely be performed preoperatively.
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Affiliation(s)
- Bingshi Zhang
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
| | - Wenao Li
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
| | - Mengnan Li
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
| | - Xuzhuang Ding
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
| | - Jia Huo
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
| | - Tao Wu
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
| | - Yongtai Han
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
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Choe H, Kobayashi N, Abe K, Hieda Y, Ike H, Kumagai K, Miyatake K, Fujisawa T, Inaba Y. Targeting of Periprosthetic Muscles for the Ultrasonographic Screening of Hip Abnormalities in Hip Resurfacing Arthroplasty Patients. J Clin Med 2023; 12:jcm12082871. [PMID: 37109208 PMCID: PMC10146634 DOI: 10.3390/jcm12082871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 03/27/2023] [Accepted: 04/12/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Hip resurfacing arthroplasty (HRA) patients require subsequent annual screening for postoperative complications. Ultrasonography may be useful for this purpose but lacks a screening protocol for hips. The purpose of this study was to evaluate the accuracy of ultrasonography for detecting postoperative complications in HRA patients using a screening protocol that specifically targets periprosthetic muscles. METHODS We enrolled 45 hips from 40 HRA patients with a mean follow-up period of 8.2 years. MRI and ultrasonography scans were simultaneously conducted at follow-up. The ultrasonography assessments were conducted on the anterior part of the hip that targets iliopsoas, sartorius, rectus femoris, lateral with anterior superior and inferior iliac spine (ASIS and AIIS) as bony landmarks, and the lateral and posterior parts that target fascia tensor, short rotators, and gluteus minimus, medius, and maximus with greater trochanter and ischial tuberosity as bony landmarks. The accuracy of diagnosing postoperative abnormalities and the visibility of periprosthetic muscles were compared between these two modalities. RESULTS Both MRI and ultrasonography detected an abnormal region in eight cases comprising two infections, two pseudotumors, and four patients with greater trochanteric bursitis. Among these cases, four hips required implant removal. The increase in anterior space, measured as the distance between the iliopsoas and resurfacing head, was a good indicator for the abnormal mass in these four HRA cases. In the assessment of periprosthetic muscles, MRI showed a much lower visibility than ultrasonography in the iliopsoas (6.7% vs. 100%), gluteus minimus (6.7% vs. 88.9%), and short rotators (8.8% vs. 71.4%) due to implant halation. CONCLUSIONS By targeting periprosthetic muscles, ultrasonography can detect postoperative complications as effectively as MRI assessments in HRA patients. Ultrasonography has superior visibility in the periprosthetic muscles of HRA patients, indicating its utility for the screening of small legions in these cases which may not be visible by MRI.
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Affiliation(s)
- Hyonmin Choe
- Department of Orthopaedic Surgery, Yokohama City University, Yokohama 236-0004, Japan
| | - Naomi Kobayashi
- Department of Orthopaedic Surgery, Yokohama City University Medical Center, Yokohama 236-0027, Japan
| | - Koki Abe
- Department of Orthopaedic Surgery, Yokohama City University, Yokohama 236-0004, Japan
| | - Yuta Hieda
- Department of Orthopaedic Surgery, Yokohama City University, Yokohama 236-0004, Japan
| | - Hiroyuki Ike
- Department of Orthopaedic Surgery, Yokohama City University, Yokohama 236-0004, Japan
| | - Ken Kumagai
- Department of Orthopaedic Surgery, Yokohama City University, Yokohama 236-0004, Japan
| | - Kazuma Miyatake
- Department of Orthopaedic Surgery, Yokohama City University, Yokohama 236-0004, Japan
| | - Takahiro Fujisawa
- Department of Orthopaedic Surgery, Yokohama City University, Yokohama 236-0004, Japan
| | - Yutaka Inaba
- Department of Orthopaedic Surgery, Yokohama City University, Yokohama 236-0004, Japan
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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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Hardwick-Morris M, Twiggs J, Miles B, Al-Dirini RMA, Taylor M, Balakumar J, Walter WL. Iliopsoas tendonitis after total hip arthroplasty : an improved detection method with applications to preoperative planning. Bone Jt Open 2023; 4:3-12. [PMID: 36598093 PMCID: PMC9887341 DOI: 10.1302/2633-1462.41.bjo-2022-0147.r1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
AIMS Iliopsoas impingement occurs in 4% to 30% of patients after undergoing total hip arthroplasty (THA). Despite a relatively high incidence, there are few attempts at modelling impingement between the iliopsoas and acetabular component, and no attempts at modelling this in a representative cohort of subjects. The purpose of this study was to develop a novel computational model for quantifying the impingement between the iliopsoas and acetabular component and validate its utility in a case-controlled investigation. METHODS This was a retrospective cohort study of patients who underwent THA surgery that included 23 symptomatic patients diagnosed with iliopsoas tendonitis, and 23 patients not diagnosed with iliopsoas tendonitis. All patients received postoperative CT imaging, postoperative standing radiography, and had minimum six months' follow-up. 3D models of each patient's prosthetic and bony anatomy were generated, landmarked, and simulated in a novel iliopsoas impingement detection model in supine and standing pelvic positions. Logistic regression models were implemented to determine if the probability of pain could be significantly predicted. Receiver operating characteristic curves were generated to determine the model's sensitivity, specificity, and area under the curve (AUC). RESULTS Highly significant differences between the symptomatic and asymptomatic cohorts were observed for iliopsoas impingement. Logistic regression models determined that the impingement values significantly predicted the probability of groin pain. The simulation had a sensitivity of 74%, specificity of 100%, and an AUC of 0.86. CONCLUSION We developed a computational model that can quantify iliopsoas impingement and verified its accuracy in a case-controlled investigation. This tool has the potential to be used preoperatively, to guide decisions about optimal cup placement, and postoperatively, to assist in the diagnosis of iliopsoas tendonitis.Cite this article: Bone Jt Open 2023;4(1):3-12.
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Affiliation(s)
- Max Hardwick-Morris
- 360 Med Care, Sydney, Australia,Flinders University, Adelaide, Australia,Correspondence should be sent to Max Hardwick-Morris. E-mail:
| | | | | | | | | | | | - William L. Walter
- Institute of Bone and Joint Research, Kolling Institute, The University of Sydney, Sydney, Australia,Department of Orthopaedics and Traumatic Surgery, Royal North Shore Hospital, Sydney, Australia
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14
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Kato M, Warashina H, Kataoka A, Ando T, Mitamura S. Localization of the ilioischial line on axial computed tomography images for preoperative planning of total hip arthroplasty. BMC Musculoskelet Disord 2022; 23:1032. [PMID: 36451146 PMCID: PMC9710038 DOI: 10.1186/s12891-022-06021-1] [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: 11/26/2021] [Accepted: 11/23/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND If the bony region indicating the ilioischial line is established on the preoperative axial computed tomography (CT) image, the distance between the simulated cup and the ilioischial line can be measured on this image so that the surgeon can use these data to define a more accurate preoperative two-dimensional (2D) template of total hip arthroplasty (THA). This study aimed to verify the hypothesis that on the CT axial image, the cortical bone area, indicated by the superimposition of a line (line α) with a perspective projection angle to the ilioischial line on radiography and tangent to the medial acetabular wall, is the cortical bone that represents the ilioischial line on radiography. METHODS Study 1: If the two measured distances (distance A' and distance B) are sufficiently equal, then the hypothesis can be supported. Distance A' was calculated by multiplying the distance A, between the ilioischial line and the medial margin of the metal cup after THA measured at the level of the hip joint center on the pelvic radiograph, by 0.91 to correct for radiographic magnification. Distance B was defined as the distance between the medial margin of the metal cup and line α on the axial CT image at the level of the hip joint center. These two distances were measured for all 51 hip joints included in the study. Study 2: The difference between distance A and distance A# (distance A on the 2D template) was compared between the group containing 59 primary THAs in which distance B' was measured (distance B in the simulation) and the control group containing 59 primary THAs. RESULTS Study 1: The average distance for A' was 4.5 ± 2 mm, and the average distance for B was 4.7 ± 2.1 mm. The difference between distances A and B was 0.2 ± 0.2 mm. Study 2: The mean difference between distance A and distance A# for the measurement and control groups was 1.8 ± 1.3 mm and 3.7 ± 2.4 mm, respectively (P < 0.001). CONCLUSIONS The ilioischial line is located in the bony region where line α intersects the medial acetabular wall with a maximum overlap on axial CT images.
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Affiliation(s)
- Michitaka Kato
- Nagoya Joint Replacement Orthopaedic Clinic, Iponbashi, Takadaji, Kita-Nagoya, Aichi 481-0011 Japan
| | - Hideki Warashina
- Nagoya Joint Replacement Orthopaedic Clinic, Iponbashi, Takadaji, Kita-Nagoya, Aichi 481-0011 Japan
| | - Akito Kataoka
- Nagoya Joint Replacement Orthopaedic Clinic, Iponbashi, Takadaji, Kita-Nagoya, Aichi 481-0011 Japan
| | - Takanori Ando
- Nagoya Joint Replacement Orthopaedic Clinic, Iponbashi, Takadaji, Kita-Nagoya, Aichi 481-0011 Japan
| | - Shingo Mitamura
- Nagoya Joint Replacement Orthopaedic Clinic, Iponbashi, Takadaji, Kita-Nagoya, Aichi 481-0011 Japan
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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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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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17
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Samim M, Khodarahmi I, Burke C, Fritz J. Postoperative Musculoskeletal Imaging and Interventions Following Hip Preservation Surgery, Deformity Correction, and Hip Arthroplasty. Semin Musculoskelet Radiol 2022; 26:242-257. [PMID: 35654093 DOI: 10.1055/s-0041-1740996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Total hip arthroplasty and hip preservation surgeries have substantially increased over the past few decades. Musculoskeletal imaging and interventions are cornerstones of comprehensive postoperative care and surveillance in patients undergoing established and more recently introduced hip surgeries. Hence the radiologist's role continues to evolve and expand. A strong understanding of hip joint anatomy and biomechanics, surgical procedures, expected normal postoperative imaging appearances, and postoperative complications ensures accurate imaging interpretation, intervention, and optimal patient care. This article presents surgical principles and procedural details pertinent to postoperative imaging evaluation strategies after common hip surgeries, such as radiography, ultrasonography, computed tomography, and magnetic resonance imaging. We review and illustrate the expected postoperative imaging appearances and complications following chondrolabral repair, acetabuloplasty, osteochondroplasty, periacetabular osteotomy, realigning and derotational femoral osteotomies, and hip arthroplasty.
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Affiliation(s)
- Mohammad Samim
- Division of Musculoskeletal Radiology, Department of Radiology, NYU Grossman School of Medicine, New York, New York
| | - Iman Khodarahmi
- Division of Musculoskeletal Radiology, Department of Radiology, NYU Grossman School of Medicine, New York, New York
| | - Christopher Burke
- Division of Musculoskeletal Radiology, Department of Radiology, NYU Grossman School of Medicine, New York, New York
| | - Jan Fritz
- Division of Musculoskeletal Radiology, Department of Radiology, NYU Grossman School of Medicine, New York, New York
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18
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Coulomb R, Nougarede B, Maury E, Marchand P, Mares O, Kouyoumdjian P. Arthroscopic iliopsoas tenotomies: a systematic review of surgical technique and outcomes. Hip Int 2022; 32:4-11. [PMID: 33226846 DOI: 10.1177/1120700020970519] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE To evaluate the technique, results and complications of arthroscopic iliopsoas tenotomies either on native hips or total hip arthroplasty (THA). METHODS A systematic review was performed using 3 databases: PubMed, EMBASE and the Cochrane library from January 2000 to December 2018 in accordance with the PRISMA procedure. The literature search, data extraction and quality assessment were conducted by 2 independent reviewers. Surgical technique, clinical outcomes, recurrences and complication rate were evaluated. RESULTS Out of 115 articles reviewed, 20 articles concerned native hips and 8 articles THA. 3 levels of release were described. For native hips, the recurrence rate was higher for central compartment than peripheral or lesser trochanter releases. Complication rates were similar for hip arthroscopy but remained low in all series. Loss of strength was evaluated mainly using the MRC muscle scale. Most studies noted strength recovery. MRI analysis of muscle atrophy was greater for lesser trochanter than for central compartment release but unrelated to loss of strength. The complication rate was low for tenotomy after THA, heterotopic ossification being the most common complication. CONCLUSIONS Central compartment releases lead to the highest rate of recurrence due to incomplete release. Peripheral releases have a potential risk of vascular injury. The lesser trochanteric approach has the disadvantage of not having direct access to the joint. The main difficulty with THA lies in the diagnosis of cup/iliopsoas impingement. Diagnostic tests with infiltration should be made before iliopsoas release to prevent its failure. Cup protrusion of over 8mm is a potential indication for acetabular revision.
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Affiliation(s)
- Remy Coulomb
- Nîmes University Hospital (CHU Nimes), Nîmes, France
| | | | - Etienne Maury
- Nîmes University Hospital (CHU Nimes), Nîmes, France
| | | | - Olivier Mares
- Nîmes University Hospital (CHU Nimes), Nîmes, France
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19
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Park HS, Lee SH, Cho HM, Choi HB, Jo S. Screw penetration of the iliopsoas muscle causing late-onset pain after total hip arthroplasty: A case report. World J Clin Cases 2021; 9:10006-10012. [PMID: 34877343 PMCID: PMC8610909 DOI: 10.12998/wjcc.v9.i32.10006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 07/25/2021] [Accepted: 09/08/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Postoperative pain following total hip arthroplasty (THA) may occur in a few patients but may pose a significant challenge to surgeons if the etiology is not identified. Herein, we report the case of a patient who developed late-onset pain following THA due to screw penetration of the iliopsoas tendon.
CASE SUMMARY We report the case of a 77-year-old man who developed inguinal pain 7 years after THA. While the symptoms resembled that of iliopsoas impingement by the acetabular cup, the pain resolved only when the supplementary acetabular screw protruding through the ilium was decompressed. Decompression was performed using the pararectus approach. The patient was able to ambulate pain-free immediately after surgery.
CONCLUSION A protruded screw through the ilium may penetrate the iliopsoas muscle, causing pain following THA. Pain may resolve with the decompression of the protruded screw.
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Affiliation(s)
- Hyung-Seok Park
- Department of Orthopaedic Surgery, Chosun University Hospital, Gwangju 61453, South Korea
| | - Sang-Hong Lee
- Department of Orthopaedic Surgery, Chosun University Hospital, Gwangju 61453, South Korea
| | - Hong-Man Cho
- Department of Orthopedics, Gwangju Veterans Hospital, Gwangju 62284, South Korea
| | - Hyun-Bai Choi
- Department of Orthopaedic Surgery, Chosun University Hospital, Gwangju 61453, South Korea
| | - Suenghwan Jo
- Department of Orthopaedic Surgery, Chosun University Hospital, Gwangju 61453, South Korea
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20
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Valenzuela J, O'Donnell JM. Endoscopic treatment of iliopsoas impingement after total hip arthroplasty: a minimum 2-year follow-up and comparison of tenotomy performed at the acetabular rim versus lesser trochanter. J Hip Preserv Surg 2021; 8:83-89. [PMID: 34567604 PMCID: PMC8460172 DOI: 10.1093/jhps/hnab035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 03/02/2021] [Accepted: 03/25/2021] [Indexed: 12/27/2022] Open
Abstract
Iliopsoas impingement is an underdiagnosed cause of groin pain after total hip arthroplasty (THA), being responsible for 4.4% of cases. Non-surgical treatment may be effective in ∼50% of cases. Endoscopic surgery has gained popularity as an option for non-responsive patients because of its non-invasive characteristics, faster recovery and encouraging results. This study compares two different sites of endoscopic psoas tenotomy performed following THA: at the edge of the acetabulum (AR) versus at the lesser trochanter (LT). This is a retrospective review of prospectively collected data from a single-surgeon case series. Thirty-five iliopsoas tenotomy cases which had >24-month follow-up were identified. There were 21 tenotomies at the lesser trochanter. Demographic data, preop and postop pain, mHHS and NAHS scores, strength and patient satisfaction data were collected and analysed. Average age at the time of surgery was 62. Mean follow-up for the LT group was 49.11 months and 42.42 months for the AR group. Pain decreased significantly for both groups (P < 0.001). Both mHHS and NAHS showed superiority in the LT group, but this difference did not reach significance (P = 0.06). LT patients showed better strength with 71.42% of them having normal strength at latest follow-up, compared with 41.6% in the AR group. There were no complications in either group. Endoscopic tenotomy is a safe and reliable surgical option, giving significant pain relief and good functional outcomes. Tenotomy at the level of the lesser trochanter might be preferable since it shows better outcomes. Larger studies are necessary to achieve statistically significant results.
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Affiliation(s)
- Joaquin Valenzuela
- Orthopaedic Surgery Department, Clínica Universidad de Los Andes, Plaza 2501, Las Condes, Santiago 7620001, Chile.,Orthopaedic Surgery Department, Complejo Asistencial Dr. Sotero del Rio. Concha y Toro 3459, Puente Alto, Santiago. 8207257
| | - John M O'Donnell
- Swinburne University of Technology, Hip Arthroscopy Australia, 21 Erin Street, Richmond, Melbourne, VIC 3121, Australia
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21
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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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22
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Campbell A, Thompson K, Pham H, Pickell M, Begly J, Wolfson T, Youm T. The incidence and pattern of iliopsoas tendinitis following hip arthroscopy. Hip Int 2021; 31:542-547. [PMID: 32093507 DOI: 10.1177/1120700020908845] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Iliopsoas tendinitis is a known source of extra-articular hip pain and it has been shown to be a common cause of continued hip pain following total hip arthroplasty. While iliopsoas tendinitis after hip arthroscopy is a well-known phenomenon amongst hip arthroscopists, its presentation, course, and treatment has yet to be elucidated. METHODS An IRB-approved chart review was performed of patients undergoing hip arthroscopy for femoroacetabular impingement (FAI) between March 2015 and July 2017. No cases of dysplasia were included. All patients had combined cam/pincer impingement as well as labral pathology. Tendinitis patients were identified. Patient demographics, surgical data, time to onset/diagnosis of iliopsoas tendinitis, treatment (oral anti-inflammatories, corticosteroid injection, physical therapy), and resolution of symptoms were recorded. These cases were age- and sex-matched to a control group that did not develop postoperative iliopsoas tendinitis for comparison. Patient outcomes were measured with the modified Harris Hip Score (mHHS) and Nonarthritic Hip Score (NAHS) recorded from the preoperative and 1-year postoperative visits. RESULTS Of 258 hip arthroscopy cases, 18 cases (7.0%) of postoperative iliopsoas tendinitis were diagnosed under high resolution ultrasound. On average, iliopsoas tendinitis was diagnosed 2.8 ± 1.8 months after surgery. There were no significant differences in age, sex, and BMI between patients that developed IP tendinitis compared to those that did not. No specific procedures were found to be significantly associated with incidence of postoperative IP tendinitis, including capsular closure.18 patients were treated with corticosteroid injection, which provided mild to moderate improvement for 5 (27.8%) patients and completely resolved symptoms for 13 patients (72.2%). Of all 18 patients with postoperative iliopsoas tendinitis confirmed by response to a diagnostic injection, 10 (55.6%) had symptoms improve within 3 months of diagnosis, 2 (11.1%) between 3 and 6 months, 4 (22.2%) between 6 and 12 months, and 2 (11.1%) after 1 year. No patients went on to have surgery for this problem. Patients with iliopsoas tendinitis had lower MHHS (p = 0.04) and NAHS (p = 0.09) scores at their 1-year postoperative visits. CONCLUSIONS Iliopsoas tendinitis is a common source of pain following arthroscopic hip surgery and can be effectively diagnosed and treated with ultrasound-guided injection. Therefore, surgeons performing arthroscopic procedures of the hip must remain aware of and include it in their differential when encountering patients with hip flexion pain after surgery. Research should be continued to further evaluate the long-term outcomes and return to sport rates of these patients.
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Affiliation(s)
- Abigail Campbell
- Department of Orthopaedic Surgery, NYU Langone Health, New York, NY, USA
| | - Kamali Thompson
- Department of Orthopaedic Surgery, NYU Langone Health, New York, NY, USA
| | - Hien Pham
- Department of Orthopaedic Surgery, NYU Langone Health, New York, NY, USA
| | - Michael Pickell
- Orthopaedic Surgery, University of Ottawa, Ottawa, ON, Canada
| | - John Begly
- Steadman-Philippon Research Institute, Vail, CO, USA
| | - Theodore Wolfson
- Department of Orthopaedic Surgery, NYU Langone Health, New York, NY, USA
| | - Thomas Youm
- Department of Orthopaedic Surgery, NYU Langone Health, New York, NY, USA
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Abstract
AIMS Iliopsoas pathology is a relatively uncommon cause of pain following total hip arthroplasty (THA), typically presenting with symptoms of groin pain on active flexion and/or extension of the hip. A variety of conservative and surgical treatment options have been reported. In this retrospective cohort study, we report the incidence of iliopsoas pathology and treatment outcomes. METHODS A retrospective review of 1,000 patients who underwent THA over a five-year period was conducted, to determine the incidence of patients diagnosed with iliopsoas pathology. Outcome following non-surgical and surgical management was assessed. RESULTS In all, 24 patients were diagnosed as having developed symptomatic iliopsoas pathology giving an incidence of 2.4%. While the mean age for receiving a THA was 65 years, the mean age for developing iliopsoas pathology was 54 years (28 to 67). Younger patients and those receiving THA for conditions other than primary osteoarthritis were at a higher risk of developing this complication. Ultrasound-guided steroid injection/physiotherapy resulted in complete resolution of symptoms in 61% of cases, partial resolution in 13%, and no benefit in 26%. Eight out of 24 patients (who initially responded to injection) subsequently underwent surgical intervention including tenotomy (n = 7) and revision of the acetabular component (n = 1). CONCLUSION This is the largest case series to estimate the incidence of iliopsoas pathology to date. There is a higher incidence of this condition in younger patients, possibly due to the differing surgical indications. Arthoplasty for Perthes' disease or developmental dysplasia of the hip (DDH) often results in leg length and horizontal offset being increased. This, in turn, may increase tension on the iliopsoas tendon, possibly resulting in a higher risk of psoas irritation. Image-guided steroid injection is a low-risk, relatively effective treatment. In refractory cases, tendon release may be considered. Patients should be counselled of the risk of persisting groin pain when undergoing THA. Cite this article: Bone Joint J 2021;103-B(2):305-308.
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Affiliation(s)
- Matthew Howell
- Queen Elizabeth University Hospital, NHS Greater Glasgow & Clyde, Glasgow, UK
| | - Fraser J Rae
- Queen Elizabeth University Hospital, NHS Greater Glasgow & Clyde, Glasgow, UK
| | - Aman Khan
- Crosshouse Hospital, NHS Ayrshire & Arran, Kilmarnock, UK
| | - Graeme Holt
- Crosshouse Hospital, NHS Ayrshire & Arran, Kilmarnock, UK
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24
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Sidhu GAS, Kaur H, Singh H, Hind J, Ashwood N. Prospective Study Showing Results of Large-Diameter Femoral Heads After Cementless Total Hip Replacement. Cureus 2021; 13:e12610. [PMID: 33585100 PMCID: PMC7877256 DOI: 10.7759/cureus.12610] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Introduction Large-diameter femoral heads (≥36 mm) were introduced to decrease instability and improve the range of motion of the hip. We hypothesized regarding the clinical outcome and complications (dislocation, implant survivorship, and functional scores) following total hip replacement (THR) surgery in an Indian population who have smaller acetabulum compared to the western population. Methodology A prospective study was conducted at a tertiary hospital from November 2011 to July 2013. A total of 70 patients with hip pathology were operated by a senior surgeon for THR using the anterolateral approach. The Harris Hip Scores were recorded pre and postoperatively in all patients. Postoperatively, radiographs were taken to check for evidence of implant loosening or osteolysis. The patients were followed up till a mean follow-up of 86.52 months (range: 74 to 108 months) in our cohort. Detailed clinical and radiographic results were available for 59 patients, while six died (three died of myocardial infarction (MI), two had cerebrovascular accident (CVA), and one patient died of pulmonary embolism) and five patients were lost to follow-up. Results Of the 59 hips, majority (76%) had acetabular inclination of 46-55 degrees. Ninety percent of the stems were in the central position and 10% were in the varus position. The average preoperative Harris Hip Score was 38.8 ± 5.7 (range: 24-46), which increased to 90.4 ± 7.3 (range: 78-94) at the last follow-up. A total of six patients died (four died of MI and two of CVA) and two patients had infection which was treated with antibiotics. Three cases of dislocation were observed; one following a fall one year after surgery and revision total hip arthroplasty was done and two cases while getting up from the bed which were managed with closed reduction and abduction brace for six weeks. Two cases of periprosthetic fracture were observed which were managed with plating. Conclusion Lower dislocation rate and better range of movement reinforces the advantage of large-diameter femoral head during THR in the Indian population.
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Affiliation(s)
- Gur Aziz Singh Sidhu
- Trauma and Orthopaedics, University Hospitals of Derby and Burton, Burton, GBR.,Trauma and Orthopaedics, Dayanand Medical College and Hospital, Ludhiana, IND
| | - Harjot Kaur
- Anesthesia, Dayanand Medical College and Hospital, Ludhiana, IND
| | - Hakam Singh
- Trauma and Orthopaedics, Dayanand Medical College and Hospital, Ludhiana, IND
| | - Jamie Hind
- Trauma and Orthopaedics, University Hospitals of Derby and Burton, Burton, GBR
| | - Neil Ashwood
- Trauma and Orthopaedics, University Hospitals of Derby and Burton, Burton, GBR
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25
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Kimura M, Kaku N, Tagomori H, Tsumura H. Effectiveness of 18F-fluoro-deoxyglucose Positron Emission Tomography/Computed Tomography and Magnetic Resonance Imaging to Detect Iliopsoas Tendonitis after Total Hip Arthroplasty: A Case Report. Hip Pelvis 2020; 32:223-229. [PMID: 33335871 PMCID: PMC7724025 DOI: 10.5371/hp.2020.32.4.223] [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: 07/31/2020] [Revised: 09/24/2020] [Accepted: 10/12/2020] [Indexed: 11/24/2022] Open
Abstract
Disorders involving artificial joints are difficult to evaluate due to metal artifacts hindering plain computed tomography (CT) or magnetic resonance imaging (MRI). In the current case study 18F-fluoro-deoxyglucose positron emission tomography (18F-FDG-PET)/CT and MRI were used to confirm iliopsoas tendonitis within the metal artifact area following total hip arthroplasty (THA). The patient was a 61-year-old woman who developed hip pain on flexion of the ipsilateral hip after THA. Imaging studies were performed to evaluate for iliopsoas tendonitis due to impingement with the cup. Assessment of the iliopsoas muscle near the artificial joint was difficult due to the metal artifact on plain CT and MRI. Imaging using 18F-FDG-PET/CT and 18F-FDG-PET/MRI showed uptake along the iliopsoas muscle. Therefore, revision was performed to resolve iliopsoas tendon impingement, and the preoperative pain resolved. The result of the current case study suggest 18F-FDG-PET/CT or 18F-FDG-PET/MRI will be useful to detect iliopsoas tendonitis within metal artifact areas after THA.
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Affiliation(s)
- Makoto Kimura
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Yufu City, Japan
| | - Nobuhiro Kaku
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Yufu City, Japan
| | - Hiroaki Tagomori
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Yufu City, Japan
| | - Hiroshi Tsumura
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Yufu City, Japan
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26
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Klemt C, Smith EJ, Oganesyan R, Limmahakhun S, Fitz D, Kwon YM. Outcome of Dual Mobility Constructs for Adverse Local Tissue Reaction Associated Abductor Deficiency in Revision Total Hip Arthroplasty. J Arthroplasty 2020; 35:3686-3691. [PMID: 32654942 DOI: 10.1016/j.arth.2020.06.043] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 06/04/2020] [Accepted: 06/16/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Treatment of adverse local tissue reaction (ALTR) is challenging owing to high complications and poor outcomes after a revision surgery. As dislocation is the most common cause of reoperation, it is often necessary to use advanced articulations such as dual mobility. This study aims to evaluate the outcome and complication rates after revision surgery with dual mobility constructs, compared to constrained and conventional articulations in the setting of significant abductor deficiency due to ALTR. METHODS Out of a total of 338 revision total hip arthroplasties for ALTR, 234 patients with a significant tissue necrosis and abductor muscle insufficiency (grade 3) were evaluated. The complication rates after revisions were compared between 42 hips with dual mobility implants, 24 hips with constrained liners, 104 hips with large diameter heads (36-40 mm), and 64 hips with small diameter heads (≤32 mm). RESULTS After an average of 4 years of follow-up (2.8-8.6), the dual mobility articulation had no dislocation, compared to 4.1% and 15.5% for constrained liner and conventional articulations, respectively (P < .001). Utilization of dual mobility and constrained liner cup also did not increase the risk of nondislocation complications, including periprosthetic joint infection and periprosthetic fracture (P = .18 and .52). CONCLUSIONS This study demonstrates significantly lower dislocation rates for dual mobility when compared to conventional articulations and comparable to constrained liners in cases of severe abductor deficiency due to ALTR, suggesting that dual mobility implants are viable surgical treatment alternatives to constrained liners to minimize dislocation during revision total hip arthroplasty in the setting of significant abductor deficiency due to ALTR.
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Affiliation(s)
- Christian Klemt
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Evan J Smith
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Ruben Oganesyan
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Sakkadech Limmahakhun
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - David Fitz
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Young-Min Kwon
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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27
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Extra-Articular Impingement at the Anterior Inferior Iliac Spine: A Cause of Refractory Periarticular Pain After Total Hip Arthroplasty. Arthroplast Today 2020; 6:845-849. [PMID: 33088882 PMCID: PMC7567039 DOI: 10.1016/j.artd.2020.07.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 06/07/2020] [Accepted: 07/10/2020] [Indexed: 11/21/2022] Open
Abstract
Background Periarticular pain after total hip arthroplasty (THA) can significantly impair the postoperative functionality. Extra-articular impingement between the greater trochanter and the anterior inferior iliac spine is presented as a cause of refractive pain after THA. Methods Twenty patients were treated for refractive periarticular pain and limited internal rotation between January 2014 and April 2016. All patients underwent a positive chair rise test, pelvic inclination test, and Marcainisation test. Patients were treated with bone resection of the anterior part of the greater trochanter with or without component revision. Results At a mean follow-up of 20 months, all functional outcomes had improved significantly. All patients were willing to undergo the surgery again. Sixteen (80%) indicated the result as very good, 3 (15%) as good, and one (5%) as poor. Two patients developed a postoperative heterotopic ossification that required resection. Conclusions Extra-articular impingement should be considered as a possible cause of refractive groin pain after THA. Bony resection through the Hueter interval provides immediate pain relief with improved functional outcomes 1 year after surgery.
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28
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Achievement of optimal implant alignment using taper wedge stems with cup-first THA through the MIS antero-lateral approach. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 30:1505-1514. [PMID: 32638123 DOI: 10.1007/s00590-020-02696-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 05/06/2020] [Indexed: 12/27/2022]
Abstract
PURPOSE Combined anteversion (CA) technique (stem-first procedure) has become generally accepted as an ideal means to achieve optimal CA value in THA. However, we hypothesized that CA technique for patients with various native femoral anteversions could pose a risk of anterior or posterior cup protrusion. In the present study, we examined whether it is possible to use the taper wedge stem to change the stem version to achieve optimal CA while avoiding cup protrusions with the cup-first procedure through minimally invasive (MIS) antero-lateral approach. METHODS Eighty-one patients underwent cup-first THA with a taper wedge stem. The acetabular cup was placed following the preoperative planning of the cup alignment to avoid anterior cup protrusions using CT-based navigation. Following the CA theory, anteversion of the taper wedge stem was changed to the target anteversion from the patient's native femoral anteversion. The native femoral anteversion, the change in version angle of the stem, postoperative CA and the length of anterior cup protrusions were evaluated in postoperative CT measurements. RESULTS The native femoral anteversion averaged 25.7° ± 8.9° (range 8°-45°). Cases with increased and decreased stem anteversion were observed in 42 hips (51.8%) and 33 hips (40.7%), respectively. The amount of increased and decreased version angles averaged 7.7° ± 4.8° (range 2°-21°) and 7.8° ± 5.1° (range 2°-20°), respectively. Postoperative CA values averaged 36.7° ± 3.4° (range 29.4°-44.2°) and anterior cup protrusion length averaged 2.0 mm ± 2.6 mm (0 ~ 8.8 mm) in axial view and 0.4 mm ± 1.0 mm (0 ~ 3.6 mm) in sagittal view. Anterior cup protrusion of more than 10 mm was not observed in any hips. CONCLUSION This procedure can be considered as an option to achieve optimal CA anteversion while avoiding anterior cup protrusion in THA.
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Peterson S. Physical therapy management of a patient with persistent groin pain after total hip arthroplasty and iliopsoas tenotomy: a case report. Physiother Theory Pract 2020; 38:481-491. [PMID: 32544015 DOI: 10.1080/09593985.2020.1768458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Hip impingement syndrome can occur after total hip arthroplasty (THA). Nonoperative treatment is inconsistently recommended, and surgical options include iliopsoas tenotomy. The current case report describes the unique case of a patient with persistent groin pain after THA and iliopsoas tenotomy. CASE DESCRIPTION The 72-year-old male had persistent groin pain after right THA and an unsuccessful iliopsoas tenotomy. He had pain and limited right hip range of motion during active and passive hip flexion, abduction, and external rotation. Treatment consisted of high-grade joint mobilization to improve the range of motion of the right hip and an exercise program. OUTCOMES The patient was treated for six visits over 3 weeks. Clinically important improvements were noted in pain, function, and perceived level of improvement. Pain during hip flexion improved on the Numeric Pain Rating Scale, and function improved on the Lower Extremity Functional Scale. Improvements in the range of motion and strength were also observed. At 6-month follow-up, he reported maintenance of improvements. DISCUSSION Joint mobilization and exercise were effective for improving range of motion, groin pain, and function in a patient with a 4-year history of persistent groin pain after THA and subsequent iliopsoas tenotomy.
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Affiliation(s)
- Seth Peterson
- Physical Therapy, The Motive, Oro Valley, AZ, USA.,Arizona School of Health Sciences, A.T. Still University, Mesa, AZ, USA
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30
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Improved accuracy of CT based measurements for anterior prominence of acetabular prosthesis using a novel protocol based on anatomical landmarks. Orthop Traumatol Surg Res 2020; 106:563-568. [PMID: 31959362 DOI: 10.1016/j.otsr.2019.10.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Revised: 10/04/2019] [Accepted: 10/11/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND Anterior hip pain after total hip replacement (THR) can be caused by iliopsoas impingement (IPI). Validation of CT measured cup version is well published; however quantification of the anterior cup prominence has not been validated. Therefore, we did an in vitro study aiming to: (1) assess the accuracy of the current method of measuring the prominence of the acetabular component using a dry bone model; (2) develop a CT protocol based on bony anatomical landmarks that improves the accuracy of these measurements. HYPOTHESIS We hypothesise that utilising reproducible anatomical landmarks on the acetabulum will improve the accuracy of measurement of anterior prominence at the psoas valley. METHODS A dry bone pelvic model was implanted with bilateral acetabular cups. The cup was manipulated into ten different combinations of inclination and version, and anterior prominence directly measured in relation to the acetabular rim. A CT scan was performed for each position. Anterior prominence was then measured by two radiologists, first using standard methods (axial slice at level of centre of femoral head) and then again using a novel protocol (based on the position of the psoas valley in relation to the inferior medial acetabular notch). RESULTS Mean errors between direct measurement of anterior prominence and radiologist reported measurements using standard protocol were 6.94mm±5.24 (SD) (95%Confidence Interval: 3.25-4.27) and 5.14mm±3.07 (95%CI: 1.9-2.5) with a tendency towards overestimation of prominence. Using an anatomical landmark based protocol; mean error was reduced to 3.0mm±1.9 (95%CI: 1.16-1.53) and 4.3mm±4.3 (95%CI: 2.67-351) on the first attempt, and to 1.7mm±1.9 (95%CI: 1.15-1.52) and 2.1mm±1.4 (95%CI: 0.87-1.15) on the second attempt. Concordance correlation improved from 0.43 (95% CI: 0.19-0.68) and 0.59 (95% CI: 0.44-0.79) using the standard protocol, to 0.88 (95%CI: 0.61-0.91) and 0.9 (95%CI: 0.56-0.92) using the novel protocol. CONCLUSIONS There is a difference in mean error and reliability between radiologically measured values for anterior prominence and values measured directly with present methods. The use of our novel protocol based on bony acetabular landmarks, significantly improves the accuracy of measurement. This protocol may improve reproducibility and the accuracy of this measurement and aid in the decision between tenotomy or revision of the acetabular component. LEVEL OF EVIDENCE III, in vitro study comparing diagnostic tools.
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Goodman SB, Gallo J, Gibon E, Takagi M. Diagnosis and management of implant debris-associated inflammation. Expert Rev Med Devices 2020; 17:41-56. [PMID: 31810395 PMCID: PMC7254884 DOI: 10.1080/17434440.2020.1702024] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 12/04/2019] [Indexed: 02/07/2023]
Abstract
Introduction: Total joint replacement is one of the most common, safe, and efficacious operations in all of surgery. However, one major long-standing and unresolved issue is the adverse biological reaction to byproducts of wear from the bearing surfaces and modular articulations. These inflammatory reactions are mediated by the innate and adaptive immune systems.Areas covered: We review the etiology and pathophysiology of implant debris-associated inflammation, the clinical presentation and detailed work-up of these cases, and the principles and outcomes of non-operative and operative management. Furthermore, we suggest future strategies for prevention and novel treatments of implant-related adverse biological reactions.Expert opinion: The generation of byproducts from joint replacements is inevitable, due to repetitive loading of the implants. A clear understanding of the relevant biological principles, clinical presentations, investigative measures and treatments for implant-associated inflammatory reactions and periprosthetic osteolysis will help identify and treat patients with this issue earlier and more effectively. Although progressive implant-associated osteolysis is currently a condition that is treated surgically, with further research, it is hoped that non-operative biological interventions could prolong the lifetime of joint replacements that are otherwise functional and still salvageable.
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Affiliation(s)
- Stuart B. Goodman
- Department of Orthopaedic Surgery, Stanford University, Redwood City, CA, USA
- Department of Bioengineering, Stanford University, Stanford, CA, USA
| | - Jiri Gallo
- Department of Orthopaedics, Palacký University Olomouc, Olomouc, Czech Republic
| | - Emmanuel Gibon
- Department of Orthopaedic Surgery, University of Florida, Gainesville, FL, USA
| | - Michiaki Takagi
- Department of Orthopaedic Surgery, Yamagata University, Yamagata, Japan
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Aspirin Thromboprophylaxis Confers No Increased Risk for Aseptic Loosening Following Cementless Primary Hip Arthroplasty. J Arthroplasty 2019; 34:2978-2982. [PMID: 31383492 DOI: 10.1016/j.arth.2019.07.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 07/06/2019] [Accepted: 07/10/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Aspirin has been shown to be a safe and cost-effective thromboprophylaxis agent with equivalent preventive efficacy to warfarin and fewer side-effects. However, animal studies have suggested delayed bone healing with aspirin and other inhibitors of prostaglandin synthesis. The impact of aspirin on aseptic loosening following cementless total hip arthroplasty (THA) has yet to be explored. Our aim was to determine if patients receiving aspirin for thromboprophylaxis had higher rates of aseptic loosening vs patients receiving warfarin after THA. METHODS We identified 11,262 consecutive primary uncemented THA performed between 2006 and 2017. Postoperatively, either warfarin (target international normalized ratio 1.5-2.0) or aspirin chemoprophylaxis were prescribed for 4 weeks. We recorded demographics, length of stay, body mass index, preoperative nonsteroidal antiinflammatory drug use, and Elixhauser comorbidity index. All revisions because of aseptic loosening within 1 year of the index procedure were identified radiographically, confirmed intraoperatively, and did not fulfill Musculoskeletal Infection Society criteria for periprosthetic infection. Multivariate logistic regression analysis was performed. RESULTS There was no difference (P = .14) in the rates of revision for aseptic loosening between patients in the aspirin cohort (14/4530; 0.31%; P = .14) and the warfarin cohort (36/6682; 0.54%). After accounting for confounding variables, no significant difference was noted in aseptic loosening rates between patients treated with aspirin vs those treated with warfarin (adjusted odds ratio 0.51; P = .11). Perioperative nonsteroidal antiinflammatory drug was not significantly associated with aseptic loosening (adjusted odds ratio 1.20; P = .67). CONCLUSION While multiple agents are available for venous thromboprophylaxis, there is increasing evidence in favor of the use of aspirin. This study allays the notion that aspirin increases the rates of aseptic loosening following uncemented hip arthroplasty.
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Masumoto Y, Fukunishi S, Fukui T, Yoshiya S, Nishio S, Fujihara Y, Okahisa S, Okada T, Kanto M, Goshi A, Morio F, Takeda Y. New combined anteversion technique in hybrid THA: cup-first procedure with CT-based navigation. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 30:465-472. [PMID: 31705402 DOI: 10.1007/s00590-019-02589-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 11/02/2019] [Indexed: 12/27/2022]
Abstract
PURPOSE Combined anteversion (CA) technique (stem-first procedure) is generally accepted as the optimal technique to attain an appropriate CA value in total hip arthroplasty (THA). However, cup anteversion is strongly influenced by the native femoral anteversion. Accordingly, anterior protrusion of the cup in the acetabulum might occur. The purpose of the present study is to investigate the achievement of the optimal CA while avoiding anterior cup protrusion and examine the significance of our new CA technique with cup-first procedure in hybrid THA. METHODS Seventy-nine hybrid THAs with the cup-first procedure used a CT-based navigation system for cup positioning. In the preoperative planning, cup anteversion was aimed at approximately 20°. However, in actuality, sufficient cup coverage in the original acetabulum based on individual anatomy is given priority over cup placement based on CT-based planning to ensure adequate cup coverage. The target stem anteversion was determined following Widmer's mathematical formula (37.3 = femoral stem anteversion × 0.7 + cup anteversion). Cemented stem was inserted according to the target stem anteversion angle. RESULTS Regarding the assessment of overall alignment, the calculated Widmer's CA values during surgery and postoperative CT evaluation were 34.1° ± 6.0° (range 20.7°-51.2°) and 35.1° ± 6.7° (range 21.6°-50.7°). There were 72 hips (91.1%) within 25°-50° of CA. Cup protrusion length averaged 2.0 mm ± 2.6 mm (0-8.8 mm) in the axial view and 0.4 mm ± 1.0 mm (0-3.6 mm) in the sagittal view. Cup protrusion length of more than 5 mm was indicated in 10 hips, and no hips observed more than 10 mm. CONCLUSION Our new CA technique (cup-first procedure) with hybrid THA was able to achieve optimal CA value while avoiding anterior cup protrusion.
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Affiliation(s)
- Yoshinobu Masumoto
- Department of Orthopedic Surgery, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan.
| | | | | | | | - Shoji Nishio
- Department of Orthopedic Surgery, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Yuki Fujihara
- Department of Orthopedic Surgery, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Shohei Okahisa
- Department of Orthopedic Surgery, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Taishi Okada
- Department of Orthopedic Surgery, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Makoto Kanto
- Department of Orthopedic Surgery, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Ariha Goshi
- Department of Orthopedic Surgery, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Futoshi Morio
- Department of Orthopedic Surgery, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Yu Takeda
- Department of Orthopedic Surgery, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
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Shapira J, Chen SL, Wojnowski NM, Lall AC, Rosinsky PJ, Maldonado DR, Domb BG. Outcomes of Nonoperative Management, Iliopsoas Tenotomy, and Revision Arthroplasty for Iliopsoas Impingement after Total Hip Arthroplasty: A Systematic Review. J Arthroplasty 2019; 34:2184-2191. [PMID: 31147246 DOI: 10.1016/j.arth.2019.04.067] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 04/11/2019] [Accepted: 04/29/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Nonoperative and operative management of iliopsoas impingement (IPI) is commonly performed following total hip arthroplasty (THA). The purpose of this systematic review is to compare patient-reported outcomes (PROs) following conservative treatment, iliopsoas (IP) tenotomy, and revision arthroplasty in patients presenting with IPI after THA. METHODS The PubMed and Embase databases were searched for articles regarding IPI following THA. Studies were included if (1) IPI after THA was treated with conservative management, an IP tenotomy, or acetabular component revision and (2) included PROs. RESULTS Eleven articles were selected for review and there were 280 hips treated for IPI following THA. Harris Hip Scores reported for the conservative group, the IP tenotomy group, and the cup revision group were 59.0 preoperatively to 77.8, 58.0 preoperatively to 85.4, and 58.1 preoperatively to 82.4 at latest follow-up, respectively. The IP tenotomy cohort also demonstrated superior postoperative functional outcomes using the Western Ontario and McMaster Universities Index, Medical Research Council score, Oxford Hip Score, and Merle d'Aubigné-Postel Pain Score. Patients who had a revision exhibited higher Oxford Hip Scores, higher Medical Research Council scores, and lower Visual Analog Scale Pain scores postoperatively. CONCLUSION Management of IPI following THA includes nonoperative measures, IP tenotomy, or acetabular component revision. Patients have been shown to experience favorable PROs at latest follow-up, with an apparent advantage for surgical treatment. Compared to revision arthroplasty, IP tenotomy resulted in a lower overall rate of complications with less severe complication types. Therefore, IP tenotomy should be considered as a second line of treatment for patients who failed conservative measures. Revision arthroplasty should be reserved for recalcitrant cases. LEVEL OF EVIDENCE IV.
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Crawford DA, Adams JB, Morris MJ, Berend KR, Lombardi AV. Revision of Failed Metal-on-Metal Total Hip Arthroplasty: Midterm Outcomes of 203 Consecutive Cases. J Arthroplasty 2019; 34:1755-1760. [PMID: 31053470 DOI: 10.1016/j.arth.2019.04.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 03/27/2019] [Accepted: 04/08/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Metal-on-metal (MoM) revisions have shown high rates of complications from aseptic loosening, deep infection, and dislocation. The purpose of this study is to report on outcomes and complications of a large consecutive series of patients who were revised for failed MoM total hip arthroplasty (THA). METHODS We evaluated 188 patients (203 hips) who underwent revisions of failed MoM THA. Mean age at the revision was 60 years old. Gender was female in 112 hips (55%) and male in 91 hips (45%). Mean interval to failure after primary THA was 4.9 years (range, 0-18 years). The acetabular component was revised in 183 cases (92%). Clinical outcomes assessed included pain score and Harris hip score. RESULTS Mean follow-up from revision was 4.2 years. Harris hip score improved from 53.6 pre-revision to 73.5 at most recent follow-up (P < .001). Pain level significantly improved from 17.2 pre-revision to 32.8 post-revision (P < .001). Reoperations occurred in 28 (14%) hips. Re-revision was required in 16 hips (7.9%). The most common reasons for re-revision were aseptic loosening (5), dislocation (3), infection (2), and iliopsoas tendonitis (2). Re-revision was significantly higher in cases of pseudotumor. There was no difference in survival with ultraporous cups. Three hips required re-revision to custom triflange components. All-cause survival was 90.5% at 4.2 years. Metal ion levels significantly declined after revision. CONCLUSION Revisions of failed MoM THA showed improvements in clinical outcomes, but present significant surgical challenges and complications especially in cases with soft tissue damage and pseudotumor.
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Affiliation(s)
| | | | - Michael J Morris
- Joint Implant Surgeons, Inc, New Albany, OH; Mount Carmel Health System, New Albany, OH
| | - Keith R Berend
- Joint Implant Surgeons, Inc, New Albany, OH; Mount Carmel Health System, New Albany, OH
| | - Adolph V Lombardi
- Joint Implant Surgeons, Inc, New Albany, OH; Mount Carmel Health System, New Albany, OH; Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH
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Zhu J, Li Y, Chen K, Xiao F, Shen C, Peng J, Chen X. Iliopsoas tendonitis following total hip replacement in highly dysplastic hips: a retrospective study. J Orthop Surg Res 2019; 14:145. [PMID: 31118071 PMCID: PMC6532264 DOI: 10.1186/s13018-019-1176-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 04/29/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND As 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. METHODS One 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. RESULTS A 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. CONCLUSIONS The 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.
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Affiliation(s)
- Junfeng Zhu
- Department of Orthopaedics, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Building 8, No.1665, Kongjiang Road, Shanghai, 200092, China
| | - Yang Li
- Department of Orthopaedics, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Building 8, No.1665, Kongjiang Road, Shanghai, 200092, China
| | | | - Fei Xiao
- Department of Orthopaedics, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Building 8, No.1665, Kongjiang Road, Shanghai, 200092, China
| | - Chao Shen
- Department of Orthopaedics, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Building 8, No.1665, Kongjiang Road, Shanghai, 200092, China
| | - Jianping Peng
- Department of Orthopaedics, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Building 8, No.1665, Kongjiang Road, Shanghai, 200092, China
| | - Xiaodong Chen
- Department of Orthopaedics, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Building 8, No.1665, Kongjiang Road, Shanghai, 200092, China.
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Total hip arthroplasty using stem-first technique with navigation: the potential of achievement of the optimal combined anteversion being a risk factor for anterior cup protrusion. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 29:807-812. [PMID: 30656429 DOI: 10.1007/s00590-019-02383-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 01/10/2019] [Indexed: 12/27/2022]
Abstract
PURPOSE In the combined anteversion (CA) technique for total hip arthroplasty (THA) with a cementless stem, cup anteversion is strongly influenced by the native femoral anteversion. It is hypothesized that in cases with large native femoral anteversion, cup anteversion can be decreased, and anterior cup protrusion from the anterior edge of the acetabulum could occur due to the achievement of optimal CA. In this study, the accuracy of CA in THA with the CA technique using imageless navigation and the relationship between the protrusion of the anterior edge of cup and optimum CA was retrospectively evaluated. METHODS Ninety-seven patients (104 hips) who underwent primary THA by the CA technique using image-free navigation were enrolled in the study. The femoral stem was placed following the individual femoral anteversion so that the target cup anteversion could be determined following a mathematical formula (37 = femoral stem anteversion × 0.7 + cup anteversion). Results The resulting CA values effectively achieved accurate CA with 39.49 ± 5.03° postoperatively. On the other hand, anterior cup protrusion was measured by computed tomography image. A cup protrusion length of more than 3 mm was indicated for 60 cases (57.7%). All included patients were divided into two groups: Group 1 as protrusion positive and Group 2 as protrusion negative. In Group 1, preoperative femoral anteversion and postoperative stem anteversion were significantly higher, while postoperative cup anteversion was significantly lower. However, the postoperative CA value indicated no significant difference between the groups. CONCLUSIONS The CA (stem-first) technique with image-free navigated THA could effectively achieve accurate CA. On the other hand, a large number of cases revealed anterior cup protrusion due to the low cup anteversion.
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Di Benedetto P, Niccoli G, Magnanelli S, Beltrame A, Gisonni R, Cainero V, Causero A. Arthroscopic treatment of iliopsoas impingement syndrome after hip arthroplasty. ACTA BIO-MEDICA : ATENEI PARMENSIS 2019; 90:104-109. [PMID: 30715007 PMCID: PMC6503398 DOI: 10.23750/abm.v90i1-s.8076] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 01/10/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND AIM OF THE WORK Groin pain after hip arthroplasty (HA) ranges from 0.4% to 18.3%. Defining the cause of groin pain after HA can be difficult. Iliopsoas impingement (IPI) has been reported to be the underlying cause of groin pain in up to 4.4% of cases. The purpose of this study is to present arthroscopic surgical outcomes in the treatment of IPI after HA. METHODS Between September 2013 and March 2018, 13 patients, 11 total hip arthroplasty (THA), 1 hip endoprosthesis and 1 total hip resurfacing affected by groin pain due to unceasing iliopsoas tendinopathy for impingement after HA were treated arthroscopically. The patients underwent to physical examination, blood analysis, hip X-rays, bone scintigraphy and CT assessment. We performed the arthroscopic OUT-IN access to hip joint in all patients. VAS scale, Harris Hip Score (HHS) and Medical Research Council (MRC) scale were performed before surgery and during follow up at 1-3-6-12 months. RESULTS After 10 months of mean follow-up, average HHS and MRC scale improved significantly from preoperatively to postoperatively. No complications arose in our case series. CONCLUSIONS Hip arthroscopy after hip arthroplasty is supported in the literature for a variety of indications. Hip arthroscopy is a viable and reproducible technique in treatment of IPI, being less invasive than the classic open technique. This simple arthroscopic release provides satisfactory results and preserves HA function. Moreover an arthroscopic OUT-IN access proves good clinical outcomes, few complications and iatrogenic lesions.
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Cadaver-Specific Models for Finite-Element Analysis of Iliopsoas Impingement in Dual-Mobility Hip Implants. J Arthroplasty 2018; 33:3574-3580. [PMID: 30029930 DOI: 10.1016/j.arth.2018.06.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 06/04/2018] [Accepted: 06/25/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Joint dislocation is a major cause of failure in total hip arthroplasty. Dual-mobility implants provide a femoral head diameter that can match the native hip size for greater stability against dislocation. However, such large heads are prone to impingement against surrounding soft tissues. To address this concern, the concept of an anatomically contoured dual-mobility implant was evaluated using cadaver-specific finite-element analysis (FEA). METHODS The stiffness of 10 iliopsoas tendons was measured and also 3D bone models, contact pressure, and iliopsoas tendon stress were evaluated for 2 implant designs according to a previous cadaveric experiment. The iliopsoas interaction with an anatomically contoured and conventional dual-mobility implant was analyzed throughout hip flexion. RESULTS The tensile test of cadaveric iliopsoas tendons revealed an average linear stiffness of 339.4 N/mm, which was used as an input for the FEA. Tendon-liner contact pressure and tendon von Mises stress decreased with increasing hip flexion for both implants. Average contact pressure and von Mises stresses were lower in the anatomically contoured design compared with the conventional implant across all specimens and hip flexion angles. CONCLUSIONS This study was built upon a previous cadaver study showing reduced tenting of the iliopsoas tendon for an anatomically contoured design compared with a conventional dual-mobility implant. The present cadaver-specific FEA study found reduced tendon-liner contact pressure and tendon stresses with contoured dual-mobility liners. Anatomical contoured design may be a solution to avoid anterior soft-tissue impingement when using hip prostheses with large femoral heads.
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Ueno T, Kabata T, Kajino Y, Inoue D, Ohmori T, Tsuchiya H. Risk Factors and Cup Protrusion Thresholds for Symptomatic Iliopsoas Impingement After Total Hip Arthroplasty: A Retrospective Case-Control Study. J Arthroplasty 2018; 33:3288-3296.e1. [PMID: 29895480 DOI: 10.1016/j.arth.2018.05.017] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 05/04/2018] [Accepted: 05/11/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Groin pain and functional limitations may occur after total hip arthroplasty (THA) due to iliopsoas impingement (IPI). We aimed to determine the risk factors and thresholds of cup protrusion for symptomatic IPI. METHODS This retrospective case-control study evaluated 569 primary THAs performed by a single surgeon in a single center. In all THAs, the cup was inserted with the assistance of the computed tomography-based navigation system. Twenty-two THAs (3.9%) were identified to have symptoms of IPI and included in the IPI group. Control group 1 comprised 547 THAs. Control group 2 (66 THAs) was formed by recruiting 3 data-matched controls per patient in control group 1. Risk factors for IPI were assessed in the IPI group and control group 1. Further analysis was performed in the IPI group and control group 2 to evaluate cup protrusion parameters measured on computed tomography images and radiographs. RESULTS Multivariate logistic regression analysis confirmed that the anterolateral approach was associated with a higher risk of IPI (odds ratio [OR], 4.20); however, its goodness of fit was low. Axial protrusion length ≥12 mm (OR, 23.29; sensitivity = 72.7; specificity = 91.0) and sagittal protrusion length ≥4 mm (OR, 61.60; sensitivity = 86.4; specificity = 78.8) were determined as independent predictors of symptomatic IPI. In the linear regression analyses, higher native acetabular version and lower cup anteversion and inclination were related to cup protrusion. CONCLUSIONS This study determined the thresholds of cup protrusion length for IPI and identified associated factors increasing cup protrusion, which are useful for surgeons in determining cup position and alignment.
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Affiliation(s)
- Takuro Ueno
- Department of Orthopedic Surgery Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Tamon Kabata
- Department of Orthopedic Surgery Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Yoshitomo Kajino
- Department of Orthopedic Surgery Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Daisuke Inoue
- Department of Orthopedic Surgery Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Takaaki Ohmori
- Department of Orthopedic Surgery Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopedic Surgery Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan
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Barrow JA, Divecha HM, Panchani S, Boden R, Porter ML, Board TN. Does oversizing an uncemented cup increase post-operative pain in primary total hip arthroplasty? EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2018; 29:97-102. [PMID: 29855788 DOI: 10.1007/s00590-018-2240-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 05/25/2018] [Indexed: 10/14/2022]
Abstract
INTRODUCTION It has been suggested that one of the factors related to persistent post-operative pain following total hip arthroplasty (THA) is to over sizing of the acetabular component. In order to investigate this potential issue, we retrospectively analysed a series of consecutive uncemented THA. We assessed the incidence of persistent post-operative pain and the size difference between the implanted acetabular component and the native femoral head. METHODS A total of 265 consecutive THAs were retrospectively identified. Standardised pre-operative radiographs were analysed using validated techniques to determine the native femoral head diameter. Post-operative standardised radiographs were reviewed and the acetabular orientation determined. Patients were sent postal questionnaires regarding their outcome and level of pain. RESULTS Questionnaires were returned by 169 patients (189 hips, 71% response rate). A total of 17 were excluded due to inadequate radiographs., leaving 172 THA in the study group. The mean native femoral head (NFH) size was 47 mm. The most common implanted acetabular component size was 52 mm. The mean difference in cup to NFH diameter (delta) was 5.7 mm (range - 6.1 to 15.4 mm; 95% CI 5.3-6.2 mm). A delta of > 6 mm was found to be significant for predicting persistent post-operative pain (RR = 1.81; 95% CI 1.1-3.1; P = 0.027). CONCLUSION Our study confirms that a delta of > 6 mm is associated with an increased risk of persistent post-operative pain following THA. We recommend pre-operative templating in all uncemented THA to ensure the planned acetabular component is no more than 6 mm larger than the NFH diameter.
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Affiliation(s)
- Jonathan A Barrow
- Centre for Hip Surgery, Wrightington Hospital, Appley Bridge, Wigan, WN4 9EP, UK.
| | - Hiren M Divecha
- Centre for Hip Surgery, Wrightington Hospital, Appley Bridge, Wigan, WN4 9EP, UK
| | - Sunil Panchani
- Centre for Hip Surgery, Wrightington Hospital, Appley Bridge, Wigan, WN4 9EP, UK
| | - Richard Boden
- Royal Preston Hospital, Sharoe Green Lane North, Fulwood, Preston, PR2 9HT, UK
| | - Martyn L Porter
- Centre for Hip Surgery, Wrightington Hospital, Appley Bridge, Wigan, WN4 9EP, UK
| | - Tim N Board
- Centre for Hip Surgery, Wrightington Hospital, Appley Bridge, Wigan, WN4 9EP, UK
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Abstract
The use of larger femoral head size in total hip arthroplasty (THA) has increased during the past decade; 32 mm and 36 mm are the most commonly used femoral head sizes, as reported by several arthroplasty registries.The use of large femoral heads seems to be a trade-off between increased stability and decreased THA survivorship.We reviewed the literature, mainly focussing on the past 5 years, identifying benefits and complications associated with the trend of using larger femoral heads in THA.We found that there is no benefit in hip range of movement or hip function when head sizes > 36 mm are used.The risk of revision due to dislocation is lower for 36 mm or larger bearings compared with 28 mm or smaller and probably even with 32 mm.Volumetric wear and frictional torque are increased in bearings bigger than 32 mm compared with 32 mm or smaller in metal-on-cross-linked polyethylene (MoXLPE) THA, but not in ceramic-on-XLPE (CoXLPE).Long-term THA survivorship is improved for 32 mm MoXLPE bearings compared with both larger and smaller ones.We recommend a 32 mm femoral head if MoXLPE bearings are used. In hips operated on with larger bearings the use of ceramic heads on XLPE appears to be safer. Cite this article: EFORT Open Rev 2018;3 DOI: 10.1302/2058-5241.3.170061.
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Affiliation(s)
- Georgios Tsikandylakis
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
- Swedish Hip Arthroplasty Register, Gothenburg, Sweden
| | - Maziar Mohaddes
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
- Swedish Hip Arthroplasty Register, Gothenburg, Sweden
| | - Peter Cnudde
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
- Swedish Hip Arthroplasty Register, Gothenburg, Sweden
- Department of Orthopaedics, Prince Philip Hospital, HDUHB, Wales
| | - Antti Eskelinen
- Coxa Hospital for Joint Replacement, Tampere, Finland
- Finnish Arthroplasty Register, Helsinki, Finland
| | - Johan Kärrholm
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
- Swedish Hip Arthroplasty Register, Gothenburg, Sweden
| | - Ola Rolfson
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
- Swedish Hip Arthroplasty Register, Gothenburg, Sweden
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O'Connell RS, Constantinescu DS, Liechti DJ, Mitchell JJ, Vap AR. A Systematic Review of Arthroscopic Versus Open Tenotomy of Iliopsoas Tendonitis After Total Hip Replacement. Arthroscopy 2018; 34:1332-1339. [PMID: 29361421 DOI: 10.1016/j.arthro.2017.10.051] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 10/01/2017] [Accepted: 10/18/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To conduct a systematic review of the literature comparing patient outcomes following arthroscopic and open operative management of iliopsoas tendonitis (IPT) following total hip replacement (THR). METHODS This review study was conducted in accordance with the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) statement. Inclusion criteria were as follows: outcome studies following open or arthroscopic iliopsoas tendon release after THR with at least 6 months of follow-up, English language, and human studies. The exclusion criteria included case reports, articles evaluating nonsurgical management or cup revision, and articles without a specific diagnosis of IPT or in which results between open and arthroscopic treatment were reported in conjunction. RESULTS A total of 131 studies were initially retrieved, with 7 satisfying all inclusion criteria (4 studies on arthroscopic tenotomy and 3 studies on open tenotomy). The review included a total of 88 patients with IPT-61 patients treated arthroscopically and 27 patients treated with open tenotomy. In total, 77 of the 88 patients demonstrated successful outcomes following surgery. In the group treated with arthroscopy, 91.8% (56/61) of patients had successful outcomes, whereas in those treated with open tenotomy, 77.8% (21/27) of patients had successful outcomes. Of patients with signs of mechanical impingement from acetabular component overhang, those who underwent open tenotomy had complete pain relief in 6/8 patients (75%) compared to arthroscopic tenotomy in which there was relief in 40/43 patients (93%). CONCLUSIONS Arthroscopic iliopsoas release for management of IPT is suggested to be an effective minimally invasive operative technique that may also yield a lower complication rate in comparison to open tenotomy. Tenotomy, both arthroscopic and open, are successful treatment options for IPT, including those with signs of mechanical impingement, and are recommended prior to cup revision. LEVEL OF EVIDENCE Level IV, systematic review of level IV studies.
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Affiliation(s)
| | | | - Daniel J Liechti
- Department of Orthopaedics, West Virginia University, Morgantown, West Virginia, U.S.A
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Zavala J, Fitace F, León M, Ponce F, Gutiérrez H. Resultados funcionales tras entrenamiento fisioterapéutico que incluye la realidad virtual en mayores de 60 años con artroplastia total de cadera: estudio descriptivo. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.ft.2017.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Capogna BM, Shenoy K, Youm T, Stuchin SA. Tendon Disorders After Total Hip Arthroplasty: Evaluation and Management. J Arthroplasty 2017; 32:3249-3255. [PMID: 28688837 DOI: 10.1016/j.arth.2017.04.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 03/20/2017] [Accepted: 04/10/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Most patients who undergo total hip arthroplasty are very satisfied with their outcomes. However, there is a small subset of patients who have persistent pain after surgery. The etiology of pain after total hip arthroplasty varies widely; however, tendon disorders are a major cause of debilitating pain that often go unrecognized. METHODS We performed a literature review to identify the most common tendon pathologies after total hip arthroplasty which include iliopsoas tendinitis, greater trochanteric pain syndrome, snapping hip syndrome, and abductor tendinopathy. RESULTS We present a simplified approach highlighting the presentation and management of patients with suspected tendinopathies after total hip arthroplasty. These tendinopathies are treatable, and management begins with nonoperative modalities; however, in cases not responsive to conservative management, operative intervention may be necessary. CONCLUSION Tendinopathies after total hip arthroplasty sometimes go unrecognized but when treated can result in higher surgeon and patient satisfaction.
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Affiliation(s)
- Brian M Capogna
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York
| | - Kartik Shenoy
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York
| | - Thomas Youm
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York
| | - Steven A Stuchin
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York
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Chalmers BP, Sculco PK, Sierra RJ, Trousdale RT, Berry DJ. Iliopsoas Impingement After Primary Total Hip Arthroplasty: Operative and Nonoperative Treatment Outcomes. J Bone Joint Surg Am 2017; 99:557-564. [PMID: 28375888 DOI: 10.2106/jbjs.16.00244] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND A potential cause of persistent groin pain after total hip arthroplasty is impingement of the iliopsoas tendon. Treatment options include conservative management, tenotomy, and acetabular revision, but the literature, to our knowledge, has been limited to small case series on each technique. We present a series of patients with iliopsoas impingement after total hip arthroplasty and evaluate efficacy and risk factors for success or failure of each treatment strategy. METHODS Forty-nine patients treated at one institution for a diagnosis of iliopsoas impingement after primary total hip arthroplasty with hemispherical acetabular component and polyethylene bearing were retrospectively reviewed. Twenty-one patients underwent acetabular revision, 8 patients underwent tenotomy, and 20 patients had nonoperative management. The mean follow-up was 4 years. Anterior acetabular component prominence was measured on true lateral hip radiographs. RESULTS At the most recent follow-up, 10 patients (50%) in the nonoperative group had groin pain resolution compared with 22 patients (76%) in the operative group (p = 0.06). In patients with <8 mm of component prominence, tenotomy provided resolution of groin pain in 5 (100%) of 5 patients and a mean Harris hip score of 89 points. In patients with ≥8 mm of prominence, acetabular revision led to groin pain resolution in 12 (92%) of 13 patients compared with 1 (33%) of 3 patients treated with tenotomy (p = 0.07). CONCLUSIONS Nonoperative management of iliopsoas impingement led to groin pain resolution in 50% of patients. In patients with minimal acetabular component prominence, iliopsoas release provided a high rate of success. Acetabular revision was more predictable for groin pain resolution in patients with ≥8 mm of anterior component prominence. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Brian P Chalmers
- 1Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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Factors associated with restricted hip extension during gait in women after total hip arthroplasty. Hip Int 2016; 25:543-8. [PMID: 26351118 DOI: 10.5301/hipint.5000286] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/05/2015] [Indexed: 02/04/2023]
Abstract
PURPOSE A decreased peak hip extension angle in the late stance phase is a major gait abnormality in patients with THA. The purpose of this study was to determine the relationship between peak hip extension angle during gait and functional impairments such as muscle weakness and the limitation in joint range of motion and to identify the clinical factors influencing peak hip extension angle during gait. METHODS 67 female volunteers with THA were examined. Biomechanical gait analysis was performed to measure peak hip extension angle during gait. Maximal isometric strength of the hip and knee, passive hip extension range of motion, leg length discrepancy, and hip pain were assessed. RESULTS Peak hip extension angle during gait significantly correlated with passive hip extension range of motion (r = 0.259), hip pain (r = -0.264), isometric strengths of the hip musculature (r = 0.278-0.491), and knee extensor (r = 0.386). Stepwise multiple regression analysis revealed that hip abductor torque (β = 0.355, P = 0.001), hip pain (β = -0.353, P = 0.001), and passive hip extension range of motion (β = 0.258, P = 0.011) were significant contributors to peak hip extension angle during gait (R2 = 0.408). CONCLUSIONS Our findings suggest that THA rehabilitation aimed at improving gait ability should focus on strengthening the hip abductors, controlling hip pain and increasing range of motion of hip extension.
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MR imaging of soft tissue alterations after total hip arthroplasty: comparison of classic surgical approaches. Eur Radiol 2016; 27:1312-1321. [DOI: 10.1007/s00330-016-4455-7] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 05/24/2016] [Accepted: 05/30/2016] [Indexed: 01/06/2023]
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The role of arthroscopy in the treatment of groin pain after total hip arthroplasty: our experience. Hip Int 2016; 26 Suppl 1:28-33. [PMID: 27174071 DOI: 10.5301/hipint.5000405] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/22/2016] [Indexed: 02/04/2023]
Abstract
AIM The purpose of the study was to present our arthroscopic surgical technique and the results in patient with pain after a hip replacement. METHODS Between November 2009 and September 2011, 35 patients with groin pain after total hip arthroplasty (THA) were treated arthroscopically. The patients underwent a preoperative examination consisting in careful history, physical examination, laboratory evaluation, diagnostic evaluation using x-rays and pelvis CT scans. In patients for whom the clinical picture suggested iliopsoas tendonitis, we also performed injection of local anaesthetic on the iliopsoas tendon sheath. All the patients were positioned in the supine decubitus position with traction applied, using 2 arthroscopic portals (AL, MID-A). An extensive debridement of adhesions, periprosthetic tissue and neocapsula were performed; when there were signs of iliopsoas impingement, a transcapsular tenotomy was performed according to Wettstein technique. RESULTS The average age was 57 (29-77) years old. The average time to onset of symptoms was 10.8 (5-15) months after THA. The average preoperative Harris Hip Score (HHS) was 44.1 (range 32-56). The average preoperative Medical Research Council (MRC) scale for muscle strenght was 3.27 (range 3-4). After 24 months of follow-up patients show an average HHS of 75.73 (range 50-91). Patients who underwent iliopsoas release show a postoperative HHS of 83.28 (range 61-91). The average postoperative MRC scale was 4.45. CONCLUSIONS Hip arthroscopy in treatment of reactive synovitis and adhesions shows good results according to literature. Hip arthroscopy in treatment of anterior iliopsoas impingement is the most useful instrument, being less invasive than the classic open technique.
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Abstract
Hip arthroplasty has become the standard treatment for end-stage hip disease, allowing pain relief and restoration of mobility in large numbers of patients; however, pain after hip arthroplasty occurs in as many as 40% of cases, and despite improved longevity, all implants eventually fail with time. Owing to the increasing numbers of hip arthroplasty procedures performed, the demographic factors, and the metal-on-metal arthroplasty systems with their associated risk for the development of adverse local tissue reactions to metal products, there is a growing demand for an accurate diagnosis of symptoms related to hip arthroplasty implants and for a way to monitor patients at risk. Magnetic resonance (MR) imaging has evolved into a powerful diagnostic tool for the evaluation of hip arthroplasty implants. Optimized conventional pulse sequences and metal artifact reduction techniques afford improved depiction of bone, implant-tissue interfaces, and periprosthetic soft tissue for the diagnosis of arthroplasty-related complications. Strategies for MR imaging of hip arthroplasty implants are presented, as well as the imaging appearances of common causes of painful and dysfunctional hip arthroplasty systems, including stress reactions and fractures; bone resorption and aseptic loosening; polyethylene wear-induced synovitis and osteolysis; adverse local tissue reactions to metal products; infection; heterotopic ossification; tendinopathy; neuropathy; and periprosthetic neoplasms. A checklist is provided for systematic evaluation of MR images of hip arthroplasty implants. MR imaging with optimized conventional pulse sequences and metal artifact reduction techniques is a comprehensive imaging modality for the evaluation of the hip after arthroplasty, contributing important information for diagnosis, prognosis, risk stratification, and surgical planning.
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Affiliation(s)
- Jan Fritz
- From the Department of Radiology and Imaging, Hospital for Special Surgery, 535 E 70th St, New York, NY 10021
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