Iliopsoas Impingement After Direct Anterior Approach Total Hip Arthroplasty: Epidemiology, Risk Factors, and Treatment Options

Buller, Leonard T.; Menken, Luke G.; Hawkins, Evan J.; Bas, Marcel A.; Roc, Gilbert C.; Cooper, H. John; Rodríguez, José A.

doi:10.1016/j.arth.2020.12.012

Cited by 20 publications

(14 citation statements)

References 25 publications

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“…Reported surgical options for treatment of iliopsoas tendinitis include arthroscopic release of the tendon only or acetabular cup revision with or without release of the iliopsoas at the lesser trochanter [3,10,14]. During acetabular component revision, it is imperative to focus attention on acetabular component position by medializing, optimizing anteversion, and in some cases allowing a more vertical position by increasing the abduction angle.…”

Section: Diagnosis and Treatmentmentioning

confidence: 99%

“…In a systematic review of hips treated for iliopsoas impingement, surgical interventions of tenotomy and/or acetabular cup revision provided the largest standardized effects in clinical outcome improvement compared to non-operative groups suggesting there is a clinical advantage using a surgical intervention to resolve groin pain associated with iliopsoas tendinitis [11]. Additional studies demonstrate advantages of surgical intervention of tenotomy and/ or acetabular cup revision for cases of iliopsoas impingement [10,14]. Specifically, Chalmers et al reported on 49 patients treated for iliopsoas impingement that groin pain resolved in only 50% of patients in the non-operative group compared to 76% of patients in the surgical intervention group [10].…”

Section: Diagnosis and Treatmentmentioning

confidence: 99%

“…While abductor tendon deficiency and muscle degeneration are reported up to 25% in some literature [4,15e18], it is reported as high as 70.9% in some elderly female populations [19]. Therefore, this debilitating complication is paramount to prevent and resolve as it may be a source of lateral hip pain for a large majority of patients following THA particularly with anterior based approaches [14]. Mild or partial abductor tendon tears can be observed at the time of routine THA and typically do not require treatment.…”

Section: Abductor Tendon Deficiencymentioning

confidence: 99%

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Diagnosis and Treatment of Musculotendinous Deficiencies of the Hip

Deckard

Meneghini

2022

The Journal of Arthroplasty

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Section: Diagnosis and Treatmentmentioning

confidence: 99%

Section: Diagnosis and Treatmentmentioning

confidence: 99%

Section: Abductor Tendon Deficiencymentioning

confidence: 99%

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Diagnosis and Treatment of Musculotendinous Deficiencies of the Hip

Deckard

Meneghini

2022

The Journal of Arthroplasty

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“…A s successful as total hip arthroplasty (THA) has been in recent decades for the treatment of numerous pathologies of the hip joint, there are still many patients who will have debilitating pain after surgery. The causes of this persistent pain are numerous, but one possibility is iliopsoas tendon impingement, which may affect up to 6% of patients 1 and is associated with prominence of the acetabular component. 2 Historically, treatment of refractory cases has centered on acetabular component revision or open iliopsoas tenotomy.…”

Section: See Related Article On Page 2820mentioning

confidence: 99%

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

Blackman¹

2021

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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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.

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“…after THA, 4,7,9,14,[17][18][19] and up to 32% of patients after hip resurfacing arthroplasty (HRA). 9,11,19 It should be noted that several of the most frequently cited papers investigating the incidence of iliopsoas impingement after THA have found the incidence to be below 5%.…”

Section: Introductionmentioning

confidence: 99%

Iliopsoas tendonitis after total hip arthroplasty

Hardwick-Morris

Twiggs²,

Miles³

et al. 2023

Bone & Joint Open

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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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Iliopsoas Impingement After Direct Anterior Approach Total Hip Arthroplasty: Epidemiology, Risk Factors, and Treatment Options

Cited by 20 publications

References 25 publications

Diagnosis and Treatment of Musculotendinous Deficiencies of the Hip

Diagnosis and Treatment of Musculotendinous Deficiencies of the Hip

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

Iliopsoas tendonitis after total hip arthroplasty

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