Iliopsoas Bursa Injections Can be Beneficial for Pain after Total Hip Arthroplasty

Abstract

Impingement of the iliopsoas tendon is an uncommon cause of groin pain after total hip arthroplasty (THA). We asked whether selective steroid and anesthetic injections for iliopsoas tendonitis after THA would relieve pain and improve function. We retrospectively reviewed 27 patients with presumed iliopsoas tendinitis treated by fluoroscopically guided injections of the iliopsoas bursa. Preand immediately postinjection, questionnaires and telephone followup questionnaires were administered to determine patient outcomes. Four patients were lost to followup and we were unable to obtain information from relatives on an additional four; the questionnaire was administered to the remaining 19 patients, including six who subsequently had surgery at an average of 44.6 months (range, 25-68 months) after their first injection. The average modified Harris hip score in the 19 patients improved from 61 preinjection to 82 postinjection and the average pain improved from 6.4 preinjection to 2.9 postinjection, but eight patients (30%) required a second injection at an average of 8.2 months after the first injection. Ultimately, six patients (22%) had an additional surgical procedure to address the underlying cause of the iliopsoas irritation. Iliopsoas tendonitis is uncommon after THA but should be considered in the differential diagnosis of all patients who present with groin pain after THA. Selective steroid and anesthetic injections of the iliopsoas bursa give adequate pain relief in the majority of patients and should be considered part of the nonoperative treatment plan before surgical release of the iliopsoas tendon or component revision.

Uncemented Porous Tantalum Acetabular Components: Early Follow-Up and Failures in 613 Primary Total Hip Arthroplasties

“…Increased anterior overhang from relative acetabular component retroversion [22] and oversizing of the cup [21] appear to be the two main technical culprits. Iliopsoas tendon sheath infiltration using local anesthetic (with or without corticosteroids) is the diagnostic modality of choice and may be therapeutic in certain cases [23,24]. More commonly, however, psoas injections fail to provide long-term relief and repeat surgery is required.…”

Image-Guided Injections of the Hip

“…As a cause of pain after total hip arthroplasty, impingement of the iliopsoas tendon reportedly occurs in up to 4.3% of patients [46]. The iliopsoas bursa and tendon can potentially be irritated by the problems related to acetabular component such as malposition, fixation screws or extruded cement debris around anterior edge of the acetabular component [47].…”

The anatomy and relevance of the iliopsoas in the young adult with hip pain: Role of arthroscopic intervention

“…19 This is commonly seen in young athletes, while secondary iliopsoas tendonitis is seen following hip arthroplasty due to chronic attrition. 20 It is commonly associated with a painful 50 30 2 years Improvement in 77% patients Ilizaturi et al 47 20 12 months Improvement in all patients with one recurrence and no complications Anderson et al 51 15 12 months Improvement in all patients with return to sport in 9 months j o u r n a l o f a r t h r o s c o p y a n d j o i n t s u r g e r y 1 ( 2 0 1 4 ) 6 6 e7 1 snapping sensation and is therefore frequently considered within the context of the snapping hip syndrome 21 ; more specifically internal snapping. 22 …”