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Skedros JG, Finlinson ED, Luczak MG, Cronin JT. Septic Olecranon Bursitis With Osteomyelitis Attributed to Cutibacterium acnes: Case Report and Literature Overview of the Dilemma of Potential Contaminants and False-Positives. Cureus 2023; 15:e34563. [PMID: 36879721 PMCID: PMC9985484 DOI: 10.7759/cureus.34563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2023] [Indexed: 02/05/2023] Open
Abstract
We report an unusual case of acute septic olecranon bursitis, with probable olecranon osteomyelitis, where the only organism isolated in culture was initially considered a contaminant, Cutibacterium acnes. However, we ultimately considered it the likely causal organism when treatment for most of the other more likely organisms failed. This typically indolent organism is prevalent in pilosebaceous glands, which are scarce in the posterior elbow region. This case illustrates the often challenging empirical management of a musculoskeletal infection when the only organism isolated might be a contaminant, but successful eradication requires continued treatment as if it is the causal organism. The patient is a Caucasian 53-year-old male who presented to our clinic with a second episode of septic bursitis at the same location. Four years prior, he had septic olecranon bursitis from methicillin-sensitive Staphylococcus aureus that was treated uneventfully with one surgical debridement and a one-week course of antibiotics. In the current episode reported here, he sustained a minor abrasion. Cultures were obtained five separate times because of no growth and difficulty eradicating the infection. One culture grew C. acnes on day 21 of incubation; this long duration has been reported. The first several weeks of antibiotic treatment failed to eradicate the infection, which we ultimately attributed to inadequate treatment of C. acnes osteomyelitis. Although C. acnes has a well-known propensity for false-positive cultures as typically reported in post-operative shoulder infections, treatment for our patient's olecranon bursitis/osteomyelitis was successful only after several surgical debridements and a prolonged course of intravenous and oral antibiotics that targeted it as the presumptive causal organism. However, it was possible that C. acnes was a contaminant/superinfection, and another organism was the culprit, such as a Streptococcus or Mycobacterium species that was eradicated by the treatment regime targeted for C. acnes.
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Affiliation(s)
- John G Skedros
- Shoulder and Elbow, Utah Orthopaedic Specialists, Salt Lake City, USA.,Department of Orthopaedics, University of Utah, Salt Lake City, USA
| | - Ethan D Finlinson
- Shoulder and Elbow, Utah Orthopaedic Specialists, Salt Lake City, USA
| | - Meredith G Luczak
- Shoulder and Elbow, Utah Orthopaedic Specialists, Salt Lake City, USA
| | - John T Cronin
- Shoulder and Elbow, Utah Orthopaedic Specialists, Salt Lake City, USA
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Williams M, Ashworth M. An operative technique for psoas impingement following total hip arthroplasty: a case series of day case, extra articular, arthroscopic psoas tenotomy. Arch Orthop Trauma Surg 2019; 139:211-216. [PMID: 30128627 DOI: 10.1007/s00402-018-3029-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Indexed: 12/27/2022]
Abstract
PURPOSE We present a prospective case series of patients undergoing an arthroscopic, extra-articular psoas tenotomy. METHODS From February 2009 to February 2017, 13 consecutive patients underwent day case, arthroscopic tenotomy. Patients were selected following clinical evidence of impingement and a diagnostic ultra-sound-guided steroid injection of the psoas bursa. The patient's mean age was 52.8 years ± 13.7 (29.1-82.7), mean ASA 1.8 and mean BMI 30.6 ± 8.5 kg/m2. We detail the technique employed and patient outcomes to include FABER testing, manual hip flexion strength assessment and pain improvements. RESULTS The typical onset of impingement symptoms following THA was 4 months (2-24 months). 9 patients tested FABER negative and 62% (n = 8) were pain-free within 6-12 weeks. An average 20% (5-30%) reduction in hip flexion strength was seen post-arthroscopy. The mean follow-up was 2 years, (0.5-7 years). Regarding complications, one patient required revision surgery due to recurrence prompting a technique adaptation. CONCLUSION For psoas impingement following THA where non-operative measures are ineffective, we recommend extra-articular arthroscopic psoas tenotomy as a feasible operative strategy. This minimally invasive, day case, low-risk treatment option is beneficial in relieving impingement symptoms.
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Affiliation(s)
- M Williams
- Department of Trauma and Orthopaedic Surgery, Torbay Hospital, Torquay, Devon, TQ2 7AA, UK.
| | - M Ashworth
- Department of Trauma and Orthopaedic Surgery, Torbay Hospital, Torquay, Devon, TQ2 7AA, UK
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Guillin R, Bertaud V, Garetier M, Fantino O, Polard JL, Lambotte JC. Ultrasound in Total Hip Replacement: Value of Anterior Acetabular Cup Visibility and Contact With the Iliopsoas Tendon. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:1439-1446. [PMID: 29171058 DOI: 10.1002/jum.14484] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 08/13/2017] [Accepted: 08/29/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To assess visibility of the acetabular cup in total hip replacement and to determine the value of direct and indirect signs of iliopsoas impingement syndrome with ultrasound. METHODS Ultrasound examinations were performed by a single operator in 17 patients with iliopsoas impingement syndrome and 48 control patients. Cup visibility, contact between the cup and psoas tendon, and the presence of indirect signs of iliopsoas impingement syndrome were investigated in all patients. When the acetabular cup was visible, its size and position in relation to the psoas tendon were recorded. RESULTS Anterior cup visibility (P = .03), contact with the psoas tendon (P < .001), psoas tendinopathy (P = .02), and iliopsoas bursitis (P < .001) were significantly associated with iliopsoas impingement syndrome, the latter reported with specificity of 100%. In the sagittal plane at the level of the psoas tendon, a maximum sagittal length of greater than 5 mm and a posteroanterior cup shift of 3 mm or greater yielded respective sensitivities of 82% and 59% and specificities of 81% and 100%. CONCLUSIONS When iliopsoas impingement syndrome is clinically suspected, the presence of iliopsoas bursitis or a posteroanterior cup shift of greater than 3 mm under the psoas tendon serve to confirm the diagnosis. In the absence of these conditions, a therapeutic test may be necessary because of the incomplete, albeit high, specificity of other signs.
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Affiliation(s)
- Raphaël Guillin
- Department of Musculoskeletal Imaging, University Hospital, Hôpital Sud, Rennes, France
| | - Valérie Bertaud
- Institut National de la Santé et de la Recherche Médicale, Unit 1099, Rennes, France
- University of Rennes 1, Rennes, France
- Departments of Dental Surgery, University Hospital of Rennes, Rennes, France
| | - Marc Garetier
- Department of Imaging, Military Teaching Hospital Clermont-Tonnerre, Brest, France
| | | | - Jean-Louis Polard
- Department of Orthopedic Surgery, University Hospital of Rennes, Rennes, France
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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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DeFrancesco CJ, Kamath AF. Abductor muscle necrosis due to iliopsoas bursal mass after total hip arthroplasty. J Clin Orthop Trauma 2015; 6:288-92. [PMID: 26566347 PMCID: PMC4600845 DOI: 10.1016/j.jcot.2015.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2014] [Accepted: 05/04/2015] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND While symptomatic iliopsoas bursal lesions have been reported after total hip arthroplasty (THA), mass effect of the collection causing abductor muscle damage has not been reported in the literature. METHODS AND RESULTS This report discusses the presentation, clinical findings, and operative management of a patient, status post metal-on-polyethylene THA, with a large psoas bursal collection with resulting abductor muscle injury and deep venous thrombosis from compression of the femoral vein. Despite the improved wear characteristics of modern-generation THA implants, physicians must be aware of the possibility of soft tissue irritation of the iliopsoas as a cause of soft tissue swelling, persistent pain, and potential adverse complications. It is also important to recognize the variety of effects and spectrum of severity for associated lesions, including muscle damage. CONCLUSIONS This report highlights the rare findings of abductor muscle necrosis, as well as acute thrombosis, related to iliopsoas bursitis. It also highlights a review of the available literature.
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Affiliation(s)
| | - Atul F. Kamath
- Assistant Professor of Orthopaedic Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA,Corresponding author at: Department of Orthopaedic Surgery, University of Pennsylvania, Pennsylvania Hospital, 8th Floor Preston, Philadelphia, PA 19107, USA. Tel.: +1 215 687 8169; fax: +1 215 829 2492.
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Tatsumura M, Mishima H, Shiina I, Hara Y, Nishiura Y, Ishii T, Ochiai N, Ishii W, Sumida T. Femoral nerve palsy caused by a huge iliopectineal synovitis extending to the iliac fossa in a rheumatoid arthritis case. Mod Rheumatol 2014. [DOI: 10.3109/s10165-007-0009-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Jerosch J, Neuhäuser C, Sokkar SM. Arthroscopic treatment of iliopsoas impingement (IPI) after total hip replacement. Arch Orthop Trauma Surg 2013; 133:1447-54. [PMID: 23884462 DOI: 10.1007/s00402-013-1806-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Indexed: 12/27/2022]
Abstract
PURPOSE The purpose of the study was to present our arthroscopic surgical technique and the results in patient with an iliopsoas impingement (IPI) syndrome after a hip replacement. MATERIALS AND METHODS Between 1999 and 2011, 35 patients with the clinical picture of an IPI after total hip replacement were diagnosed and treated arthroscopically. The age was ranged from 58 to 82 years. All patients underwent conservative treatment for at least 6 months without success. The indication for the arthroscopic procedure was the failure of the conservative therapy as well as typical clinical signs as painful hip flexion, a positive local anesthesia test and radiological evidence of the presence of a prominent anterior acetabular component. The arthroscopic treatment was performed in all patients with anterior capsulotomy and partial capsulectomy of the hip joint. After identification of the pathology an arthroscopic release of the iliopsoas tendon in the region of the proved lesion was performed. The average follow-up period was 3.6 years (6 months to 12 years). RESULTS In all patients osseous integrated acetabular components were found. In six cases there was a surface replacement, in three cases it was a cementless screw-in cup and in the other three cases it was a cementless modular press-fit cup. 8 out of 12 patients suffered from a hip dysplasia with a secondary osteoarthritis. After establishing an anterior capsular window arthroscopically, the iliopsoas tendon could be visualized in all cases. In addition to multiple local tendinitis all patients already showed mechanical limitation with partial rupture of variable extent in the iliopsoas tendon. During the arthroscopy the lesion was detected at the level of the anterior prominent acetabular component as well as distal to it. 10 out of 12 patients reported immediately after postoperative mobilization that the typical preoperative complaints have disappeared. Two patients still had residual pain. In one of those patients this was relieved by the time of the follow-up examination. Clinically a temporary weakness of hip flexion in the first days of the postoperative period was detected. In the first follow-up 6 weeks later there was no evidence of weakness in any of the patients. CONCLUSION AND CLINICAL RELEVANCE An arthroscopic release of the iliopsoas tendon with evidence of iliopsoas impingement after total hip replacement gives predictably good results. A clinically relevant weakness of hip flexion is not expected after the procedure.
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Affiliation(s)
- Jorg Jerosch
- Clinic for Orthopedics and Trauma Surgery and Sports Medicine, Johanna-Etienne Hospital, 41462, Neuss, Germany,
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Yoshihara Y, Shiromoto Y, Tatsumi M, Hirano M, Kawano T, Arino H, Osako M, Nemoto K. Backflow from a Metallosis-Induced Intrapelvic Mass into a Revision Hip Arthroplasty: A Case Report. JBJS Case Connect 2013; 3:e66. [PMID: 29252466 DOI: 10.2106/jbjs.cc.l.00201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Yasuo Yoshihara
- Departments of Orthopaedic Surgery (Y.Y., Y.S., M.T., M.H., T.K., H.A., and K.N.) and Cardiovascular Surgery (M.O.), National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama 3598513, Japan.
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9
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Acute inguinal pain associated with iliopectineal bursitis in four professional soccer players. Diagn Interv Imaging 2013. [DOI: 10.1016/j.diii.2012.10.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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10
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Lax Pérez R, Salinas Gilabert JE, Lajara Marco F, Lax Pérez A, Ferrero Manzanal F, García-Gálvez A, Izquierdo Plazas L. [Femoral superficial vein thrombosis due to a large iliopsoas bursitis secondary to polyethylene wear debris in total hip arthroplasty]. Rev Esp Cir Ortop Traumatol (Engl Ed) 2012. [PMID: 23177944 DOI: 10.1016/j.recot.2011.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
A 76 year old male patient with a history of implantation of a total hip arthroplasty Perfecta (Orthomet(®)), who presented with an iliac fossa mass, increased diameter of the thigh, and pain during hip flexion and extension. CT and ultrasound show the presence of a giant cystic mass in left iliac fossa about 7 cm in diameter next to the prosthesis. A pseudo-tumour secondary to wear debris after placement of a total arthroplasty is rare. We present a case of a large iliopsoas bursitis caused by polyethylene particles, which caused compression and thrombosis of the superficial femoral vein.
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Affiliation(s)
- R Lax Pérez
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Santa María del Rosell, Cartagena, Murcia, España.
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Lax Pérez R, Salinas Gilabert J, Lajara Marco F, Lax Pérez A, Ferrero Manzanal F, García-Galvez A, Izquierdo Plazas L. Femoral vein thrombosis due to a large iliopsoas bursitis secondary to polyethylene wear debris in total hip arthroplasty. Rev Esp Cir Ortop Traumatol (Engl Ed) 2012. [DOI: 10.1016/j.recote.2011.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Delaunay C, Petit I, Learmonth ID, Oger P, Vendittoli PA. Metal-on-metal bearings total hip arthroplasty: the cobalt and chromium ions release concern. Orthop Traumatol Surg Res 2010; 96:894-904. [PMID: 20832379 DOI: 10.1016/j.otsr.2010.05.008] [Citation(s) in RCA: 141] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2010] [Revised: 05/08/2010] [Accepted: 05/14/2010] [Indexed: 02/02/2023]
Abstract
With certain concerns recently reported on metal-on-metal bearing couples in total hip arthroplasty, this study's objective is to review the current knowledge concerning release of metal ions and its potential consequences. Each metal-on-metal implant presents different tribological properties. The analytical techniques for metals are accurate and the Co ion rates seem acceptable up to 2 μg/L. A delayed type IV hypersensitivity reaction (atypical lymphocytic vasculitis-associated lesion [ALVAL]) may be the source of arthroplasty failure. Idiosyncratic, it remains unpredictable even using cutaneous tests and apparently is rare (0.3%). Today, there are no scientific or epidemiologic data supporting a risk of carcinogenesis or teratogenesis related to the use of a metal-on-metal bearings couple. Solid pseudotumors nearly exclusively are observed with resurfacing procedures, carrying a high annual revision rate in women under 40 years of age, occurring particularly in cases of acetabular malposition and with use of cast molded Cr-Co alloys. Osteolysis manifests through complete and progressive radiolucent lines or through cavitary lesions stemming from ALVAL-type alterations or impingement problems or implant incompatibility. The formation of wear debris exceeding the biological tolerance is possible with implant malposition, subluxation, and jamming of the femoral head in cases of cup deformity. Moreover, each implant presents different metal ion production; assessment of their performance and safety is required before their clinical use. With the knowledge available today, metal-on-metal bearing couples are contraindicated in cases of metal allergies or end stage renal dysfunction and small size resurfacing should cautiously be used.
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Affiliation(s)
- C Delaunay
- De l'Yvette Private Hospital, 67, route de Corbeil, 91160 Longjumeau, France.
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Pandher DS, Boparai RS, Kapila R. Biceps tendinitis as a cause of acute painful knee after total knee arthroplasty. J Arthroplasty 2009; 24:1292.e15-8. [PMID: 19409751 DOI: 10.1016/j.arth.2009.01.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2008] [Accepted: 01/30/2009] [Indexed: 02/01/2023] Open
Abstract
The case report highlights an unusual case of posterolateral knee pain after total knee arthroplasty. Tendinitis of the patellar tendon or pes anserinus is a common complication after total knee arthroplasty; however, there is no report in the literature regarding the biceps femoris tendinitis causing acute pain in the early postoperative period. In this case, the biceps tendinitis was diagnosed and treated by ultrasound-guided injection into the tendon sheath.
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Park KS, Diwanji SR, Kim HK, Song EK, Yoon TR. Hemorrhagic iliopsoas bursitis complicating well-functioning ceramic-on-ceramic total hip arthroplasty. J Arthroplasty 2009; 24:826.e1-5. [PMID: 18701239 DOI: 10.1016/j.arth.2008.06.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2007] [Accepted: 06/09/2008] [Indexed: 02/01/2023] Open
Abstract
Iliopsoas bursitis has been increasingly recognized as a complication of total hip arthroplasty and is usually associated with polyethylene wear. Here, the authors report a case of hemorrhagic iliopsoas bursitis complicating an otherwise well-functioning ceramic-on-ceramic arthroplasty performed by minimal invasive modified 2-incision technique. The bursitis in turn resulted in femoral nerve palsy and femoral vein compression. In this report, there was no evidence to support that the bursitis was due to an inflammatory response to ceramic wear particles or any other wear particles originating from the total hip arthroplasty.
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Affiliation(s)
- Kyung Soon Park
- Center for Joint Disease, Chonnam National University Hwasun Hospital, Ilsim-Ri, Hwasun-Eup, Hwasun-Gun, Jeonnam 519-809, South Korea
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Abstract
Anterior iliopsoas impingement and tendinitis is a poorly understood and likely underrecognized cause of groin pain and functional disability after total hip arthroplasty. The patient history and physical examination findings are usually only suggestive, and the symptoms frequently subtle. The diagnosis may be confirmed by one or more imaging studies, including a cross-table lateral radiograph, computed tomography, magnetic resonance imaging, and ultrasonography, in combination with a confirmatory diagnostic injection. Nonsurgical management may not resolve the problem. Surgical treatment, consisting of release or resection of the iliopsoas tendon, alone or in combination with acetabular revision for an anterior overhanging component, usually provides permanent pain relief.
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Lorenzo LD, Jennifer Y, Pappagallo M. Psoas impingement syndrome in hip osteoarthritis. Joint Bone Spine 2009; 76:98-100. [DOI: 10.1016/j.jbspin.2008.04.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2007] [Accepted: 04/23/2008] [Indexed: 11/26/2022]
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Abstract
Despite the curvaceous profile of the acetabulum, orthopaedic surgeons have continued to implant hemispheric cups since the introduction of total hip arthroplasty. The geometric discrepancies between the natural acetabulum and implant can result in painful iliopsoas impingement attributable to prosthetic overlap at the anterior acetabular ridge over which the iliopsoas tendon extends to leave the pelvis. We expanded on previous in vitro observations of acetabular morphology using a large in vivo sample and quantified the dimensions of the psoas valley. We studied computed tomographic scans of 200 healthy hips from 50 men and 50 women. The acetabular ridges were digitized on three-dimensional bone reconstructions and their coordinates were manipulated in spreadsheets to deduce acetabular diameter, anteversion, and inclination and to plot the rim profile. Our results confirm the acetabular rim is an asymmetric succession of three peaks and three troughs. The psoas valley has the following shape distribution: 79% curved, 11% angular, 10% irregular, and 0% straight. The mean depth of the psoas valley is 5 mm and the latitude of its trough is on average 6 mm below the acetabular equator. The use of side-specific cups that replicate the curvaceous acetabular profile could prevent prosthetic overlap and reduce the incidence of iliopsoas impingement.
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Femoral nerve palsy caused by a huge iliopectineal synovitis extending to the iliac fossa in a rheumatoid arthritis case. Mod Rheumatol 2008; 18:81-5. [PMID: 18180875 DOI: 10.1007/s10165-007-0009-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2007] [Accepted: 09/11/2007] [Indexed: 01/15/2023]
Abstract
We report on a 54-year-old woman with rheumatoid arthritis who had severe femoral nerve palsy affected by a distended synovium in the hip joint. Surgical exploration demonstrated a perforation of the iliopectineal bursa connecting with the hip joint. The patient fully recovered from femoral nerve palsy after surgery. It was considered that synovitis of the hip joint had developed following huge iliopectineal bursitis.
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Vandenbussche E, Saffarini M, Delogé N, Moctezuma JL, Nogler M. Hemispheric cups do not reproduce acetabular rim morphology. Acta Orthop 2007; 78:327-32. [PMID: 17611844 DOI: 10.1080/174536707100013870] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Iliopsoas impingement is a recurrent complication following THA, caused by muscle friction against a protrusive prosthetic cup.This study was designed to quantify the dimensional variations in acetabular rim profiles, with particular regard to the iliopubic valley, in order to suggest means to prevent iliopsoas impingement. MATERIAL AND METHODS 34 cadaver pelvises were analyzed using a hip navigation system. The morphometric data were processed to plot profiles of all acetabular rims with particular regard to the shape and depth of the psoas valley. RESULTS The acetabular rim is an asymmetric succession of 3 peaks and 3 troughs. The psoas valley is a salient feature in most pelvises and there is only a weak correlation between its depth (mean 3.8 mm, SD 2.0) and acetabular diameter, anteversion, or inclination. INTERPRETATION It would be difficult to obviate the anterior overlap of the acetabulum using a hemispheric cup, a fortiori in certain morphotypes, without compromising range of motion or risk of dislocation. The solution for prevention of iliopsoas impingement would be to adapt cup design to acetabular anatomy, which may require different implants for the right and left sides, and hence a doubled inventory.
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Affiliation(s)
- Eric Vandenbussche
- Department of Orthopaedic Surgery, Hôpital Européen Georges Pompidou, 20 Rue Leblanc, FR-75908 Paris, France.
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Grosclaude S, Adam P, Besse JL, Fessy MH. Masse inguinale révélatrice d’une complication d’une arthroplastie totale de hanche. ACTA ACUST UNITED AC 2006; 92:351-7. [PMID: 16948462 DOI: 10.1016/s0035-1040(06)75765-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The iliopsoas bursa is situated immediately anterior to the hip joint. Communication can develop between a hip prosthesis and the iliopsoas bursa leading to distension and formation of an inguinal mass revealing complication of total hip arthroplasty. We report five clinical cases. The five patients with a total hip arthroplasty developed a mass in the Scarpa triangle which correlated with defective prosthesis function. We chose not to dissect the cystic mass but to treat the intra-articular cause. Symptoms resolved after the intervention in all cases. This rare condition should be envisioned if an inguinal mass develops or has a functional impact, particularly on the lymphovenous circulation. Anatomic relations can be distinguished with computed tomography. Prosthetic complications include infection, loosening or wear. The work-up should include search for infection and standard x-rays of the hip joint. Before surgery, duplex Doppler should be performed systematically to search for a thromboembolic complication.
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Affiliation(s)
- S Grosclaude
- Centre d'Orthopédie-Traumatologie, Pavillon 1-3, Hôpital Bellevue, CHRU de Saint-Etienne, 42055 Saint-Etienne Cedex 02.
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Cyteval C, Sarrabère MP, Cottin A, Assi C, Morcos L, Maury P, Taourel P. Iliopsoas impingement on the acetabular component: radiologic and computed tomography findings of a rare hip prosthesis complication in eight cases. J Comput Assist Tomogr 2003; 27:183-8. [PMID: 12703010 DOI: 10.1097/00004728-200303000-00014] [Citation(s) in RCA: 95] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To describe the radiographic and computed tomography (CT) scan features of iliopsoas impingement on the acetabular component (IPI) in total hip arthroplasty. METHOD Eight cases of iliopsoas impingement were diagnosed and confirmed by surgical revision. The plain film radiograph findings and CT scan findings were compared with those of two control populations (8 patients with painless total hip prosthesis and 16 patients with other complications confirmed by surgical revision). RESULTS An oversized cup was found in four hips with IPI (50%) and in one hip with another complication (6%). Coronal inclination of the acetabular cup was normal in the IPI group and in the two control groups, with a similar mean cup size. All patients with IPI had an acetabular cup overhang of more than 12 mm. Conversely, in the two control groups, the overhang, present in three and two cases, respectively, was always less than 8 mm. Iliopsoas bursal effusion was present in four hips with IPI and three hips with other complications and was never present in normal prostheses. CONCLUSION More than a 12-mm overhang of the acetabular cup is a sensitive and specific parameter for diagnosing IPI.
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22
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Yamamoto T, Marui T, Akisue T, Yoshiya S, Hitora T, Kurosaka M. Dumbbell-shaped iliopsoas bursitis penetrating the pelvic wall: a rare complication of hip arthrodesis. A case report. J Bone Joint Surg Am 2003; 85:343-5. [PMID: 12571315 DOI: 10.2106/00004623-200302000-00025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Tetsuji Yamamoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Chuo-ku, Japan.
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23
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Abstract
Enlarged iliopectineal bursitis in the hip region, which usually occurs with degenerative, infectious, or traumatic disorders, is relatively rare. Iliopectineal bursitis complicating bipolar hemiarthroplasty is even more rare. Reported here is an unusual case of a patient with an inguinal mass presenting 8 years after bipolar hemiarthroplasty. Enlarged bursitis complicating the hip prosthesis is rare and has been described only anecdotally in the literature. The enlarged iliopectineal bursa arises from the hip, and the most apparent cause of its formation is polyethylene debris. Treatment should be directed at the source of the debris intraarticularly. Wearing of the polyethylene insert was difficult to discern radiographically for this patient; it was seen on the scout film of the computed tomography of the pelvis while evaluating the enlarged bursitis. The scout film of the computed tomography and the two-dimensional reconstruction of computed tomograms of the hip may be helpful in evaluating wearing of the polyethylene insert.
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Affiliation(s)
- Y M Lin
- Department of Orthopedic Surgery, Veterans General Hospital-Taichung, Taiwan
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24
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Abstract
Determination of the cause of groin pain after total hip arthroplasty can be difficult. The case of a patient with an unusual cause of groin pain after total hip arthroplasty, iliopsoas tendinitis, is presented. The patient failed nonoperative treatment and underwent surgical release of the iliopsoas tendon with complete resolution of symptoms.
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Affiliation(s)
- C J Della Valle
- Department of Orthopaedic Surgery, New York University-Hospital for Joint Diseases, New York City, New York, USA
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25
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Al-Khodairy AT, Gobelet C, Nançoz R, De Preux J. Iliopsoas bursitis and pseudogout of the knee mimicking L2-L3 radiculopathy: case report and review of the literature. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 1997; 6:336-41. [PMID: 9391806 PMCID: PMC3454611 DOI: 10.1007/bf01142682] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We report the case of a 74-year-old woman who presented with acute-onset right groin pain irradiating to the thigh anteriorly after having suffered for a few weeks from slight knee pain. As a CT scan showed multiple herniated intervertebral discs and spinal stenosis at the L3-L4 level, she was referred to a neurosurgical unit with the tentative diagnosis of L2-L3 radicular pain. Investigations (MR, myelography with CT scan) showed severe acquired lumbar canal stenosis. Decompression surgery was finally postponed because of the patient's serious cardiac medical history and she was referred to us for conservative treatment. She was found to have iliopsoas bursitis with chondrocalcinosis of the knee. Local steroid injections of the two sites abolished her symptoms. We draw attention to the possible pitfalls that the radiographic appearance and one of the multiple clinical presentations of this unrare pathology may represent. Whenever a patient comes walking with crutches, avoids putting weight on his or her leg, and radicular pain is suspected, we advise consideration of other extra-spinal causes for the pain.
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Affiliation(s)
- A T Al-Khodairy
- Department of Physical Medicine and Rehabilitation, Hôpital de Gravelone, Sion, Switzerland
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26
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Wilson T, Horne G, Holloway L. Capsular chondroid metaplasia following total hip arthroplasty. THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY 1997; 67:298-300. [PMID: 9152165 DOI: 10.1111/j.1445-2197.1997.tb01971.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- T Wilson
- Department of Orthopaedics, Wellington Hospital, New Zealand
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27
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Goyal S, Moss MC, Breusch SJ. Venous outflow obstruction 8 years following Ring total hip arthroplasty. A rare complication of acetabular loosening and polyethylene wear. ACTA ORTHOPAEDICA SCANDINAVICA 1997; 68:67-9. [PMID: 9057572 DOI: 10.3109/17453679709003979] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- S Goyal
- Department of Orthopaedics, St. Richard's Hospital, Chichester, West Sussex, U.K
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28
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Abstract
A 50-year-old man developed a pelvic mass following uncemented total hip arthroplasty. The mass communicated with the hip via an acetabular defect after loosening of the acetabular component. Operative and histologic findings revealed a foreign body reaction to polyethylene debris. Revision arthroplasty and excision of the pelvic mass were performed successfully through a single incision. A mass adjacent to a loose prosthesis may present as polyethylene failure following total hip arthroplasty. Revision arthroplasty and excision of the mass after an accurate diagnosis are recommended.
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Affiliation(s)
- J W Wang
- Department of Orthopaedic Surgery, Chang Gung Medical College, Taiwan, Republic of China
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29
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Abstract
Nine cases of septic bursitis are presented, and the literature on the subject comprehensively reviewed, with an emphasis on the clinical manifestations of septic bursitis in various anatomic locations. Physical activities associated with increased susceptibility to septic bursitis and systemic conditions that increase the severity of septic bursitis are catalogued. Analysis of the microbiology of cases reported in the literature demonstrates that greater than 80% of cases of septic bursitis are caused by Staphylococcus aureus and other gram-positive organisms. However, a wide variety of gram-negative microorganisms, fungi, and other infectious agents have been reported to cause septic bursitis and may lead to complications in diagnosis and treatment. The nine cases reported here demonstrate the potential severity of septic bursitis and emphasize that significant systemic complications may result from this common musculoskeletal infection. Indications for hospitalization and/or intravenous antibiotic therapy for septic bursitis include the presence of fulminant local infection, evidence for systemic toxicity, or infection in an immunocompromised patient. Patients who fail to respond to intravenous antibiotics and percutaneous aspiration of the bursa may require surgical drainage or bursectomy by one of several methods that have been proposed. There is some recent evidence that intrabursal corticosteroid injection for therapy of nonseptic subcutaneous bursitis may be more effective than systemic antiinflammatory medication or simple bursa aspiration.
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Affiliation(s)
- B Zimmermann
- Department of Medicine, Brown University School of Medicine, Providence, RI, USA
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30
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Meaney JF, Cassar-Pullicino VN, Etherington R, Ritchie DA, McCall IW, Whitehouse GH. Ilio-psoas bursa enlargement. Clin Radiol 1992; 45:161-8. [PMID: 1555365 DOI: 10.1016/s0009-9260(05)80632-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The clinical and radiological features of 14 patients with ilio-psoas bursal enlargement associated with articular disease of the hip are presented. The condition primarily affects patients over the range of 50 years with pre-existing hip disease, usually of long duration. A clinical diagnosis before investigation was never made in our series as the symptoms were non-specific and varied, consisting of pain (40%), a palpable groin mass (40%) and lower limb swelling (28%). The diagnosis can be made pre-operatively and the extent along the path of the ilio-psoas accurately delineated. The bursal contents, although predominantly fluid in nature, do include a varying proportion of solid components. Ultrasound is the simplest, quickest and most cost effective means of demonstrating the hip effusion, the bursa, its contents and extent. Although the compressive effects are well seen sonographically, computed tomography (CT) and magnetic resonance imaging (MRI) provide a better appreciation of the regional anatomy and hip joint disease.
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Affiliation(s)
- J F Meaney
- Department of Diagnostic Imaging, Robert Jones & Agnes Hunt Orthopaedic Hospital, Oswestry
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31
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Toohey AK, LaSalle TL, Martinez S, Polisson RP. Iliopsoas bursitis: clinical features, radiographic findings, and disease associations. Semin Arthritis Rheum 1990; 20:41-7. [PMID: 2218552 DOI: 10.1016/0049-0172(90)90093-u] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Inflammation of the iliopsoas bursa is a common manifestation of a wide array of inflammatory, degenerative, and traumatic musculoskeletal conditions. The clinical presentation of iliopsoas bursitis is variable, and includes pain, mass lesion, or compression syndromes of the inguinal compartment. Affected individuals frequently have underlying synovitis of the hip or a history of occupational or recreational injury. Early and accurate diagnosis is facilitated by appropriate radiographic studies.
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Affiliation(s)
- A K Toohey
- Department of Medicine, Duke University Medical Center, Durham, NC 27710
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Sartoris DJ, Danzig L, Gilula L, Greenway G, Resnick D. Synovial cysts of the hip joint and iliopsoas bursitis: a spectrum of imaging abnormalities. Skeletal Radiol 1985; 14:85-94. [PMID: 4023747 DOI: 10.1007/bf00349741] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Synovium-related soft tissue disease around the hip constitutes a spectrum ranging from isolated iliopsoas bursitis to pure articular synovial herniations without bursal involvement. The clinical, pathologic, and radiographic features of these entities are discussed as they pertain to the variety of underlying disorders which predispose to their occurrence. Nine case reports are utilized to illustrate the variable clinical and radiographic presentations which may be encountered. Based upon these cases as well as those in the literature, an imaging algorithm has been developed which should eliminate unnecessary studies and allow prompt and accurate diagnosis.
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