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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; 42:2035-2042. [PMID: 38587991 DOI: 10.1002/jor.25856] [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: 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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Albano D, Cintioli R, Messina C, Serpi F, Gitto S, Mascitti L, Vignati G, Glielmo P, Vitali P, Zagra L, Snoj Ž, Sconfienza LM. US-Guided Interventional Procedures for Total Hip Arthroplasty. J Clin Med 2024; 13:3976. [PMID: 38999539 PMCID: PMC11242179 DOI: 10.3390/jcm13133976] [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: 04/30/2024] [Revised: 06/23/2024] [Accepted: 07/04/2024] [Indexed: 07/14/2024] Open
Abstract
In patients with total hip arthroplasty (THA) with recurrent pain, symptoms may be caused by several conditions involving not just the joint, but also the surrounding soft tissues including tendons, muscles, bursae, and peripheral nerves. US and US-guided interventional procedures are important tools in the diagnostic work-up of patients with painful THA given that it is possible to reach a prompt diagnosis both directly identifying the pathological changes of periprosthetic structures and indirectly evaluating the response and pain relief to local injection of anesthetics under US monitoring. Then, US guidance can be used for the aspiration of fluid from the joint or periarticular collections, or alternatively to follow the biopsy needle to collect samples for culture analysis in the suspicion of prosthetic joint infection. Furthermore, US-guided percutaneous interventions may be used to treat several conditions with well-established minimally invasive procedures that involve injections of corticosteroid, local anesthetics, and platelet-rich plasma or other autologous products. In this review, we will discuss the clinical and technical applications of US-guided percutaneous interventional procedures in painful THA that can be used in routine daily practice for diagnostic and therapeutic purposes.
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Affiliation(s)
- Domenico Albano
- IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy
- Dipartimento di Scienze Biomediche, Chirurgiche ed Odontoiatriche, Università degli Studi di Milano, 20122 Milan, Italy
| | - Roberto Cintioli
- Postgraduate School of Diagnostic and Interventional Radiology, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milan, Italy
| | - Carmelo Messina
- IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, 20122 Milan, Italy
| | - Francesca Serpi
- IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, 20122 Milan, Italy
| | - Salvatore Gitto
- IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, 20122 Milan, Italy
| | - Laura Mascitti
- Postgraduate School of Diagnostic and Interventional Radiology, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milan, Italy
| | - Giacomo Vignati
- Postgraduate School of Diagnostic and Interventional Radiology, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milan, Italy
| | - Pierluigi Glielmo
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, 20122 Milan, Italy
| | - Paolo Vitali
- IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, 20122 Milan, Italy
| | - Luigi Zagra
- IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy
| | - Žiga Snoj
- Clinical Radiology Institute, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
- Department of Radiology, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Luca Maria Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, 20122 Milan, Italy
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Marth AA, Ofner C, Zingg PO, Sutter R. Quantifying cup overhang after total hip arthroplasty: standardized measurement using reformatted computed tomography and association of overhang distance with iliopsoas impingement. Eur Radiol 2024; 34:4300-4308. [PMID: 38147169 PMCID: PMC11213778 DOI: 10.1007/s00330-023-10479-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/20/2023] [Accepted: 10/24/2023] [Indexed: 12/27/2023]
Abstract
OBJECTIVES Currently, there is no standardized measurement method for evaluating cup overhang (CO) in patients undergoing total hip arthroplasty (THA). We propose a novel, standardized method of measuring overhang distance in patients following primary total hip arthroplasty (THA) on computed tomography (CT) images after multiplanar reformation and compare it to a previously proposed measurement method on sagittal CT images. MATERIALS AND METHODS This retrospective study included patients who underwent primary THA with an anterior approach. Patients with cup overhang (CO) and iliopsoas impingement (IPI) were identified by clinical and imaging data. Uncorrected overhang distance (ODu) was evaluated on orthogonal sagittal CT images while corrected overhang distance (ODc) was evaluated on reformatted sagittal CT images corrected for pelvic rotation and aligned with the plane of the cup face. RESULTS Out of 220 patients with THA, 23 patients (10.4%) with CO and 16 patients (7.3%) with IPI were identified. CO was significantly associated to IPI (p < 0.001). The inter- and intrareader agreement was almost perfect for ODc (κ = 0.822, κ = 0.850), whereas it was fair and moderate for ODu (κ = 0.391, κ = 0.455), respectively. The discriminative ability of ODc was excellent (area under the curve (AUC) = 0.909 (95% confidence interval (CI) 0.784-1.000)) in the receiver operating characteristic analysis. Conversely, AUC for ODu was poor, measuring 0.677 (95% CI 0.433-0.921). CONCLUSION We implemented a novel measurement method for CT images reformatted at the plane of the cup face to assess overhang distance in patients with CO following THA. CLINICAL RELEVANCE STATEMENT While further validation is necessary, the proposed method is characterized by its high reproducibility and might be used to predict the occurrence of iliopsoas impingement in patients with cup overhang following total hip arthroplasty. KEY POINTS • A novel, standardized method of measuring cup overhang distance in patients following primary total hip arthroplasty on CT images is proposed. • Cup overhang was associated to iliopsoas impingement. The proposed method was reproducible and showed excellent prediction of iliopsoas impingement in patients with cup overhang. • This method can be implemented in clinical practice when assessing CT images of patients with cup overhang for iliopsoas impingement.
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Affiliation(s)
- Adrian A Marth
- Swiss Center for Musculoskeletal Imaging, Balgrist Campus AG, Zurich, Switzerland.
- Department of Radiology, Balgrist University Hospital, Faculty of Medicine, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.
| | - Christian Ofner
- Department of Radiology, Balgrist University Hospital, Faculty of Medicine, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Patrick O Zingg
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Reto Sutter
- Department of Radiology, Balgrist University Hospital, Faculty of Medicine, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
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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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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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