Iliopsoas impingement after revision total hip arthroplasty treated with iliopsoas muscle transection

Morohashi, Itaru; Homma, Yasuhiro; Kanda, Akio; Yamamoto, Yasuhiro; Obata, Hiroyuki; Mogami, Atsuhiko; Obayashi, Osamu

doi:10.1016/j.amsu.2016.03.004

Cited by 9 publications

(9 citation statements)

References 10 publications

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“…The present findings are supported by previous studies highlighting the importance of back problems, which worsen the results of THA and lead to poor results [12,13]. Periarticular pain is poorly described: the best described is iliopsoas impingement, because of its surgical treatment [14,15], but we found no studies of prevalence. Loosening is not the most common cause of painful THA, whereas it is the most common cause of revision; however, it represented only 10% of painful prostheses in the present series, so the other causes have to be borne in mind.…”

Section: Discussionsupporting

confidence: 89%

Painful Hip Arthroplasty: What Should We Find? Diagnostic Approach and Results

Érivan¹,

Villatte²,

Ollivier³

et al. 2019

The Journal of Arthroplasty

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Introduction: Identifying the source of pain is paramount for determining appropriate treatment and ensuring successful outcome in terms of management and relief of pain. The difficulty is that each surgeon has his or her own way of seeing the problem, and there is no consensus for the evaluation of these patients. The study hypothesis was that it is possible to find the cause of the pain in most cases. Patients and methods: All patients consulting for unexplained painful hip arthroplasty were included and followed a decision tree to assess the cause of the pain. The primary endpoint was the final diagnosis. Secondary endpoints were subgroup comparison between main causes and assessment of risk factors. Results: Two hundred one hips of 194 patients were included as unexplained painful hip arthroplasty 6 months postoperatively. Final diagnoses comprised periarticular pain in 53 cases (26.4%): 40 cases of trochanteric bursitis, 5 of iliopsoas tendinitis, 5 of abductor deficiency, 1 of ischial tuberosity tendinitis, and 2 of heterotopic ossification; projected pain in 49 (24.4%): 45 cases of back pain with or without neuropathy, 3 of knee osteoarthritis, and 1 of metabolic neuropathy; wear in 40 (19.9%), in the polyethylene liner; loosening in 20 (10.0%): loosening of the femoral component in 8 and that of the cup in 12; material problems in 17 (8.5%): trunnionosis in 13 and metallosis in metal-on-metal implants in 4; no diagnosis in 7 hips (3.5%); infection in 6 (3.0%), all chronic; instability without real dislocation in 3 (1.5%); misplacement in 3 (1.5%), all for leg-length discrepancy; fracture in 2 (1.0%): 1 of greater trochanter and 1 of ilio-ischiopubic ramus; complex regional pain syndrome in 1 (0.5%). Discussion: To our knowledge, this is the first study on the causes of painful hip arthroplasty in clinical practice, whether leading to revision or not. A systematic approach, including physical examination, radiographic assessment and laboratory studies, is needed to find the cause of the pain. It is important to understand the pain so that it can be treated appropriately. Revision surgery can sometimes helpdbut the worst thing is to make the patient worse.

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Section: Discussionsupporting

confidence: 89%

Painful Hip Arthroplasty: What Should We Find? Diagnostic Approach and Results

Érivan¹,

Villatte²,

Ollivier³

et al. 2019

The Journal of Arthroplasty

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“…We concur with Morohashi et al. 9 that unexpected adhesions from the previous surgery may be encountered. When releasing the iliopsoas tendon at the lesser trochanter, metachronous proximal adhesions of the tendon may be present either to the proximal femoral at the level of the neck cut or to the anterior acetabular margin or to the anterior lip of the component itself.…”

Section: Discussionsupporting

confidence: 93%

Arthroscopic Identification and Management of Recurrent Iliopsoas Impingement After Total Hip Arthroplasty

Thaunat

Barbosa

Clowez

et al. 2018

Arthroscopy Techniques

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Arthroscopic release of the iliopsoas tendon for iliopsoas impingement (IPI) after total hip arthroplasty (THA) at the lesser trochanter gives good results. However, where IPI then recurs, due to adhesions between the healing iliopsoas tendon and the surrounding soft tissue, and nonoperative measures have failed, a revision THA procedure is usually considered. We propose a technique of arthroscopic visualization of the recurrent IPI and a subsequent psoas tenotomy at the level of the hip joint using an outside-in capsulotomy approach. This secondary tenotomy, located proximally directly at the level of the recurrent impingement, allows relief of the painful symptoms without compromising the muscle function of the iliopsoas and precludes the need for a complex THA revision.

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“…A recent literature review found an overall success rate of 91.5% for surgical intervention at a mean of 22.7 months postoperatively [18, 19]. Compared to iliopsoas tenotomy, associated iliopsoas tenotomy and component revision presented similar functional outcomes but a higher rate of complications [18, 23, 25]. Single iliopsoas tenotomy could be appropriate for patients without radiographic evidences of the acetabular component malposition.…”

Section: Discussionmentioning

confidence: 99%

Iliopsoas tendonitis following total hip replacement in highly dysplastic hips: a retrospective study

Zhu

Chen

et al. 2019

J Orthop Surg Res

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Background As a recognized cause of groin pain following total hip arthroplasty, iliopsoas tendonitis probably results from different factors. Given the anatomic disadvantage, dysplastic hips theoretically make acetabular component relatively retroverted or oversized, screws implanted frequently, and iliopsoas tendonitis more likely. However, the prevalence and mechanism of iliopsoas tendonitis following total hip replacement in dysplastic hips are not fully understood. Methods One hundred and thirty-three total hip arthroplasties for Crowe type 2 to 4 dysplastic hips were compared with 126 total hip arthroplasties for hips without dysplasia in this study. Preoperative patient demographic data were well matched between the groups. Clinical and radiographic evaluations were performed. Results A significantly higher frequency of protruded screws (24.8% vs 0), anterior overhang of acetabular components (30.8% vs 4.0%), and increased leg lengthening (3.6 [2.0–6.8] vs 0.5 [0–1.8]) was found in the dysplastic group (all p values < 0.05). However, the femoral offset and inclination and anteversion of acetabular components between the groups did not differ significantly. No difference in the prevalence of iliopsoas tendonitis was found between the groups. A new cause of iliopsoas tendonitis following total hip arthroplasty was detected in the dysplastic group. The iliopsoas tendonitis was irritated by an instable artificial femoral head. Conclusions The dysplastic hips did not present a higher incidence of postoperative iliopsoas tendonitis in this study. Iliopsoas tendonitis could be somewhat prevented by smaller size of acetabular components and soft tissue release in dysplastic hips, but irritated by an instable artificial femoral head.

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Iliopsoas impingement after revision total hip arthroplasty treated with iliopsoas muscle transection

Cited by 9 publications

References 10 publications

Painful Hip Arthroplasty: What Should We Find? Diagnostic Approach and Results

Painful Hip Arthroplasty: What Should We Find? Diagnostic Approach and Results

Arthroscopic Identification and Management of Recurrent Iliopsoas Impingement After Total Hip Arthroplasty

Iliopsoas tendonitis following total hip replacement in highly dysplastic hips: a retrospective study

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