Arthroscopic iliopsoas tenotomy after total hip arthroplasty: safe method for the right patient

Abstract

Purpose To evaluate the outcome of arthroscopic treatment for iliopsoas impingement after total hip arthroplasty (THA) 2 years after surgery using patient reported outcomes (PROM). Methods In this study 12 patients (13 hips) were included from a local hip arthroscopy registry. Patients completed web-based PROMs preoperatively and at a minimum of 2 years postoperatively. The PROMs included the International Hip Outcome Tool short version (iHOT-12), the Copenhagen Hip and Groin Outcome Score (HAGOS), the European Quality of Life-5 Dimensions Questionnaire (EQ-5D), the Hip Sports Activity Scale (HSAS) for physical activity level, the Visual Analog Scale (VAS) for overall hip function and a single question regarding overall satisfaction with the surgery. Results The mean age was 64.4 years (±15.1SD), mean body mass index (BMI) was 26.6 (±4.3SD), mean follow-up time was 49.8 months (±25SD). Comparing PROMs preoperatively with 2-year follow up showed an improvement for many of the PROMs used. The PROMs scores were iHOT-12 (24.9 vs 34.5, p = 0.13), HAGOS subscales (symptoms 38.2 vs 54.5, p = 0.05; pain 36 vs 53, p = 0.04; sport 14.1 vs 35.1, p = 0.03; daily activity 31 vs 47.5, p = 0.04; physical activity 21.8 vs 24, p = 0.76; quality of life 24 vs 35, p = 0.03), EQ-VAS (57.9 vs 58, p = 0.08), EQ-5D (0.34 vs 0.13, p = 0.07) and VAS for overall hip function (43.1 vs 46.2, p = 0.14). In total, 10 out of the 12 patients (83%) were satisfied with the intervention. Conclusion Patients undergoing surgery for iliopsoas impingement after previous THA showed improved self-reported hip function where most patients were satisfied with treatment.

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

“…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]. Additionally, studies on open tenotomy have also reported good clinical outcomes, with mean post-tenotomy HHS between 80-86 points, but higher complication rates of 17%, and revision rates of up to 13% [7,13].…”

“…Additionally, studies on open tenotomy have also reported good clinical outcomes, with mean post‐tenotomy HHS between 80–86 points, but higher complication rates of 17%, and revision rates of up to 13% [7, 13]. Endoscopic tenotomy has been shown to provide better outcomes than non–surgical treatments [34], and is advantageous over arthroscopic and open tenotomy, as arthroscopic tenotomy is more difficult to perform and is associated with risks of scratching the prosthetic femoral head or destabilizing the joint, while open tenotomy is more invasive and results in higher complication rates [7, 12–14, 24, 30, 32, 34, 36, 38, 46].…”