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

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.

Satisfactory mid‐term clinical outcomes of endoscopic tenotomy for iliopsoas tendinopathy following total hip arthroplasty

“…At a minimum follow-up of five years, the present study revealed a significant improvement in mHHS and OHS, exceeding the MCID in 92.5% of patients, as well as a satisfaction rate of 92.5%, and a rate of cup (with or without stem) revision of 14% (n = 8), although only two reoperations were directly linked to a failed tenotomy. These findings are in agreement to previous published studies on endoscopic tenotomy, that have reported satisfaction rates of 71-93%, mHHS between 75-89 points, and complication rates of 2-10% [2,3,17,26,41]. Studies on arthroscopic tenotomy have reported mean post-tenotomy HHS between 82-92 points and few to no complications and revisions [12,14,24,30,32,34,38,46].…”