Iliopsoas Impingement: A Report of 2 Cases

Dalmau‐Carolà, Joan

doi:10.1111/papr.12086

Cited by 2 publications

(1 citation statement)

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“…We compared this navigation-guided technique with the standard estimation of cup position by eye and palpation as usually performed in clinical practice. In terms of psoas impingement, other than various case reports [5,6], one study described an association of psoas impingement to the difference between native acetabular and acetabular component version [13]. However, to the best of our knowledge, no randomized comparative trials are available that compare intraoperative techniques regarding their effect on prevention of potential psoas impingement in THA.…”

Section: Introductionmentioning

confidence: 99%

Navigation is Equal to Estimation by Eye and Palpation in Preventing Psoas Impingement in THA

Weber

Woerner

Messmer

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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Background Iliopsoas tendon impingement is one possible reason for persistent groin pain and diminished functional outcome after THA. So far, estimation by eye and palpation is the standard procedure to intraoperatively assess the distance of the cup to the anterior rim. However, novel technologies such as imageless navigation enable intraoperative measurements of the cup in relation to the psoas tendon and bony landmarks. Questions/purposes We asked whether psoas impingement (1) can be reduced using imageless navigation compared with the standard technique and (2) is associated with specific patient characteristics. Furthermore, we investigated (3) if anterior cup protrusion (overhang) is associated with lower outcome scores for pain and function.Methods The current study is a reanalysis of data from a randomized controlled trial evaluating navigation for THA; 135 patients were randomized for surgery with or without the use of imageless navigation. The risk for anterior protrusion of the cup above the acetabular rim and thus potential psoas impingement, defined as an overhang of the cup above the anterior acetabular rim as measured on postoperative CT, was either controlled with the help of navigation or standard control by eye and palpation intraoperatively. Postoperatively, the anterior protrusion of the cup above the acetabular rim was measured on three-dimensional (3-D) CT by a blinded, external institute. In addition to patient-related outcome measures, the Harris hip score, Hip disability and Osteoarthritis Outcome Score, and EuroQol were obtained 1 year postoperatively. Altogether 123 data sets were available for primary analysis and 115 were available for 1-year followup. Results There was no difference, with the numbers available, between the navigated and the control groups in terms of the mean distance of the cup below the anterosuperior acetabular rim (3.9 mm; À5.3 to 12.6 mm versus 4.4 mm; À7.9 to 13.7 mm; p = 0.72) or the anteroinferior acetabular rim (4.7 mm; À6.2 to 14.8 mm versus 4.2 mm; À7.1 to 16.3 mm; p = 0.29). There was no difference, with the numbers available, in terms of the proportion of cups with anterior overhang (7%, four of 57 versus, 15%, 10 of 66; p = 0.16), respectively. After controlling for potential confounding variables such as cup inclination, cup size, patient age, BMI, stage of arthritis, and length of skin incision, we found cup anteversion (hazard ratio [HR], 0.87; 95% CI, 0.81-0.93; p \ 0.001) and female sex (HR, 3.88; 95% CI, 1.01-14.93; p = 0.049) were associated with a propensity to potential psoas impingement. With the numbers available, there were no differences observed in

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Section: Introductionmentioning

confidence: 99%