Endoscopic Iliopsoas Tenotomy for Iliopsoas Impingement on a Collared Femoral Prosthesis

Lindner, Diana; Stake, Christine E.; Bitar, Youssef F. El; Jackson, Timothy J.; Domb, Benjamin G.

doi:10.1016/j.eats.2013.02.008

Cited by 14 publications

(17 citation statements)

References 17 publications

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“…In a case report, Brew et al ( 2011 ) confirmed that, because of a large protruding collar, their patient had iliopsoas tendonitis and required revision surgery. In another case report, Linder et al ( 2013 ) found that iliopsoas tenotomy relieved similar symptoms.…”

Section: Discussionmentioning

confidence: 84%

“…1a and b) (Meding et al, 1997 ), an oversized collar may lead to painful prosthetic impingement against the ilipsoas or other soft tissues (Fig. 1c ) (Brew et al, 2011 ; Lindner et al, 2013 ). To the authors’ knowledge, however, there are no published studies that investigated optimal collar dimensions in relation to stem size or neck angle.…”

Section: Introductionmentioning

confidence: 99%

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Proximal femoral anatomy and collared stems in hip arthroplasty: is a single collar size sufficient?

Bonin¹,

Gedouin

Pibarot

et al. 2017

J EXP ORTOP

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BackgroundEven if the benefits of collars are unclear, they remain widely used, in several femoral stem designs. This study aimed to determine whether collar size should be proportional to hip dimensions and morphology. The hypothesis was that the collar should be larger for greater stem sizes and for varus femoral necks.MethodsComputed Tomography scans of 204 healthy hips were digitally analysed and manually templated to determine principle dimensions, appropriate stem size and model, as well as cortical distance at the femoral calcar (ideal collar size).ResultsUnivariable analysis revealed that cortical distance was moderately correlated with mediolateral offset (r = 0.572; p < 0.0001) and stem model (r = 0.520; p < 0.0001). Cortical distance was weakly correlated with head diameter (r = 0.399; p < 0.0001), stem size (r = 0.200; p = 0.017), and patient gender (r = 0.361; p < 0.0001). Multivariable analysis confirmed that stem model (p < 0.0001) and head diameter (p = 0.0162) are directly correlated to cortical distance.ConclusionWe found that cortical distance along the femoral calcar is directly correlated with the model of the stem implanted (‘standard’ or ‘varus’) and with the head diameter. This cortical distance indicates optimal collar size, which would grant maximum calcar coverage without prosthetic overhang. Collar size should be proportional to the size of the operated hip, and should be larger for ‘varus’ stem models than for ‘standard’ stem models.

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Section: Discussionmentioning

confidence: 84%

Section: Introductionmentioning

confidence: 99%

Proximal femoral anatomy and collared stems in hip arthroplasty: is a single collar size sufficient?

Bonin¹,

Gedouin

Pibarot

et al. 2017

J EXP ORTOP

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“…The strength of the present study is that our design provided the most efficient scheme for rare factors with sufficient sample size because it only focused on the effect of the femoral component on IPI, after ruling out the effect of the acetabular component, the liner, and the femoral head. Only two case reports documented several cases of IPI when using a collared femoral prosthesis [ 15 , 16 ]. They failed to provide convincible evidences regarding the associated effect of the collar on impingement due to their limited cases.…”

Section: Discussionmentioning

confidence: 99%

“…Several national joint registries reported a significant trend in favor of collar use, showing collared stems had a statistically significant difference in risk of subsidence and peri-prosthetic fracture in comparison to collarless stems [ 13 , 14 ]. As an underestimated factor, a collared femoral prosthesis has been regarded as an unusual cause of IPI in only two case reports [ 15 , 16 ]. In these studies, the authors reported a limited number of patients with persistent groin pain, which was all caused by the impingement between the metal collar and the iliopsoas tendon as it overhung the calcar.…”

Section: Introductionmentioning

confidence: 99%

Risk factors for iliopsoas impingement after total hip arthroplasty using a collared femoral prosthesis

Qiu

Chen

et al. 2020

J Orthop Surg Res

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Background The relationship between collar design of a femoral component and iliopsoas impingement (IPI) after total hip arthroplasty (THA) is still underrecognized. The purpose of our study was to determine the possible risk factors for IPI related to the femoral component, when using a collared femoral prosthesis. Methods A total of 196 consecutive THA patients (206 hips) using a collared femoral prosthesis were reviewed retrospectively after exclusion of the factors related to acetabular component and femoral head. The patients were divided into +IPI and −IPI group according to the presence of IPI. Radiological evaluations were performed including femoral morphology, stem positioning, and collar protrusion length (CPL). Multivariate regression analysis was performed to assess the risk factors for IPI. Results At a minimum follow-up of 1 year, IPI was observed in 15 hips (7.3%). Dorr type C proximal femur was found in nine hips (60%) in the +IPI group and in 28 hips in the −IPI group (14.7%, p < 0.001). The mean stem anteversion in the +IPI group was significantly greater than that in the −IPI group (19.1° vs. 15.2°, p < 0.001), as well as the mean CPL (2.6 mm vs. − 0.5 mm, p < 0.001). The increased stem anteversion ( OR = 1.745, p = 0.001) and CPL ( OR = 13.889, p = 0.001) were potential risk factors for IPI. Conclusions The incidence of IPI after THA is higher than expected when using a collared femoral prosthesis. Among the factors related to collared femoral prosthesis, excessively increased stem anteversion and prominent collar protrusion are independent predictors for IPI. In addition, high risk of IPI should be carefully considered in Dorr type C bone, despite that femoral morphology is not a predictive factor. Level of evidence Level IV, clinical cohort study

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“…Treatment of painful internal snapping syndrome or iliopsoas (IP) impingement with arthroscopic iliopsoas fractional lengthening (IFL), in the setting of femoroacetabular impingement (FAI) and labral tear, is a safe procedure with good short to mid-term follow-up results and associated improvement in patient-reported outcome scores (PROs) 1,4,5,8,9 . Surgical management of IP impingement is typically performed arthroscopically in 1 of 2 ways: transcapsular tenotomy from the central or peripheral compartment or extracapsular tenotomy at the tendon's insertion on the lesser trochanter 1,8,10 .…”

Section: Introductory Statementmentioning

confidence: 99%

Arthroscopic Iliopsoas Fractional Lengthening

Maldonado

Lall

Battaglia

et al. 2018

JBJS Essential Surgical Techniques

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Background: Iliopsoas fractional lengthening (IFL) is performed on patients with symptomatic internal snapping. This condition is defined as painful and sometimes audible snapping of the iliopsoas (IP) tendon over the femoral head or iliopectineal line. Arthroscopic IFL is performed if the snapping is unresponsive to conservative treatment 1,2. Description: Hip arthroscopy is performed with the patient in the supine position on a traction table. The portals used to access the joint capsule include standard anterolateral, mid-anterior, and distal anterolateral accessory (DALA) portals 3. With a 70°arthroscope, diagnostic arthroscopy is conducted to assess the quality of labral tissue, acetabular and femoral cartilage surfaces, and the ligamentum teres. When indicated, supplementary procedures, such as acetabuloplasty, labral repair, or labral reconstruction 4 , are performed prior to IFL. With traction still applied, IFL is then performed from the central compartment at the level of the joint line. Exposure of the IP tendon is achieved with the use of a curved blade to extend the capsulotomy medially over the 3 o'clock position (right hip). Once the tendon can be appropriately visualized, a progressive and complete transverse cut is made in the tendinous portion, taking care to avoid the muscular portion. During this process, the anterolateral and mid-anterior portals serve as visualization and working portals, respectively 5. Alternatives: Prior to arthroscopic IFL for painful internal snapping, nonsurgical options 6,7 may include (1) physical therapy programs, (2) activity modification, (3) nonsteroidal anti-inflammatory drugs (NSAIDs), or (4) ultrasound-guided cortisone injections. Disclosure: The authors indicated that no external funding was received for any aspect of this work. On the Disclosure of Potential Conflicts of Interest forms, which are provided with the online version of the article, one or more of the authors checked "yes" to indicate that the author had a relevant financial relationship in the biomedical arena outside the submitted work and "yes" to indicate that the author had other relationships or activities that could be perceived to influence, or have the potential to influence, what was written in this work (http://links.lww.com/JBJSEST/A229).

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Endoscopic Iliopsoas Tenotomy for Iliopsoas Impingement on a Collared Femoral Prosthesis

Cited by 14 publications

References 17 publications

Proximal femoral anatomy and collared stems in hip arthroplasty: is a single collar size sufficient?

Proximal femoral anatomy and collared stems in hip arthroplasty: is a single collar size sufficient?

Risk factors for iliopsoas impingement after total hip arthroplasty using a collared femoral prosthesis

Arthroscopic Iliopsoas Fractional Lengthening

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