Editorial Commentary: Iliopsoas Tenotomy for Pain After Total Hip: A Great Operation IF the Diagnosis Is Right

Abstract

Iliopsoas tendon pain can be a frustrating condition for both patients and surgeons after total hip arthroplasty. It is difficult to diagnose definitively, as there is no imaging modality that offers reliable information and there are numerous causes of persistent groin pain in this patient population. The pain can ruin the results of an otherwise wellfunctioning total hip arthroplasty. Patients who respond best to arthroscopic iliopsoas tenotomy are those with isolated pain with hip flexion activities and reproducible pain with resisted hip flexion on examination or other provocative iliopsoas maneuvers. Patients with these symptoms in addition to more generalized pain findings (pain with weightbearing, pain at night, pain with passive range of motion) tend not to respond as favorably to isolated iliopsoas tenotomy. In addition, optimal treatment for refractory cases has been controversial historically, as both acetabular component revision and iliopsoas tendon lengthening have been advocated. With the ever-increasing popularity of hip arthroscopy and recent clinical outcome reports, arthroscopic (or endoscopic) iliopsoas tenotomy has proven to be a very safe and effective treatment option for these patients, with one caveat: the diagnosis must be correct.

Sequential Treatment of Iliopsoas Tendon Cysts Combined With Medial Hip Snapping by Hip Arthroscopy

“…With the mature development of hip arthroscopy technology, arthroscopy has been well used in the treatment of femoroacetabular impingement, ischiofemoral impingement, and gluteus medius tendon injury. Blackman 10 suggested that once isolated pain in the hip originates from iliopsoas tendon tightness, arthroscopic severance of the tendon is a very safe and effective treatment modality. The theory provides a theoretical basis for the choice of tendon dissection in this operation.…”

Arthroscopic Iliopsoas Fractional Lengthening After Total Hip Arthroplasty: Using the Iliopsoas Air Bursogram Technique to Hit the Target

“…As with any surgery, a mutual decision between the surgeon and the patient is determined based on indications, 6 potential risks, and benefits of the procedure. In terms of indications, acetabular component revision is often reserved for patients with significant implant malposition (≥8 mm acetabular prominence).…”

Arthroscopic Peripheral Compartment Iliopsoas Release for Iliopsoas Impingement After Primary Total Hip Arthroplasty

“… 3 , 4 , 5 Additionally, lumbar spine, intra-abdominal, retro-peritoneal and vascular pathologies should be evaluated. 6 , 7 Screening for these entities is outside the scope of this technique article.…”