Iliopsoas pathology after total hip arthroplasty: a young person’s complication

Abstract

Aims Iliopsoas pathology is a relatively uncommon cause of pain following total hip arthroplasty (THA), typically presenting with symptoms of groin pain on active flexion and/or extension of the hip. A variety of conservative and surgical treatment options have been reported. In this retrospective cohort study, we report the incidence of iliopsoas pathology and treatment outcomes. Methods A retrospective review of 1,000 patients who underwent THA over a five-year period was conducted, to determine the incidence of patients diagnosed with iliopsoas pathology. Outcome following non-surgical and surgical management was assessed. Results In all, 24 patients were diagnosed as having developed symptomatic iliopsoas pathology giving an incidence of 2.4%. While the mean age for receiving a THA was 65 years, the mean age for developing iliopsoas pathology was 54 years (28 to 67). Younger patients and those receiving THA for conditions other than primary osteoarthritis were at a higher risk of developing this complication. Ultrasound-guided steroid injection/physiotherapy resulted in complete resolution of symptoms in 61% of cases, partial resolution in 13%, and no benefit in 26%. Eight out of 24 patients (who initially responded to injection) subsequently underwent surgical intervention including tenotomy (n = 7) and revision of the acetabular component (n = 1). Conclusion This is the largest case series to estimate the incidence of iliopsoas pathology to date. There is a higher incidence of this condition in younger patients, possibly due to the differing surgical indications. Arthoplasty for Perthes' disease or developmental dysplasia of the hip (DDH) often results in leg length and horizontal offset being increased. This, in turn, may increase tension on the iliopsoas tendon, possibly resulting in a higher risk of psoas irritation. Image-guided steroid injection is a low-risk, relatively effective treatment. In refractory cases, tendon release may be considered. Patients should be counselled of the risk of persisting groin pain when undergoing THA. Cite this article: Bone Joint J 2021;103-B(2):305–308.

Increased hip flexion angle and protrusion of the anterior acetabular component can predict symptomatic iliopsoas impingement after total hip arthroplasty: a retrospective study

“…ROM is higher in patients with osteonecrosis than in those with osteoarthritis because of a shorter disease duration, less deformity of the hip joint, and a thinner hip capsule. Howell et al 7 reported a higher incidence of IPI in hips with osteonecrosis than in those with primary osteoarthritis (18.8% vs. 1.5%) too. A larger area of the iliopsoas muscle is irritated by the edge of the cup in cases with a higher hip flexion angle and for this reason an inflammatory reaction might be accelerated.…”

The changing face of clinical practice

“…In such cases, we sometimes may choose to proceed to arthroplasty early, but must do so cautiously and with full disclosure of the possible outcomes and the pitfalls of surgery. [7][8][9][10] We are currently at an interesting time when many patients are diagnosed with osteoarthritis at a younger age than previously, and when some are unwilling to accept restrictions on their social and sporting activities. We are then faced with difficult decisions.…”

Cup Overhanging in Anatomic Socket Position or High Hip Center of Rotation in Total Hip Arthroplasty for Crowe III and IV Dysplasia: A CT-Based Simulation

“…Iliopsoas impingement is an uncommon cause of groin pain after total hip arthroplasty (THA), occurring in 2–5% of the implants [ 1 , 2 ]. Cup overhanging has been advocated as one of the most important causative factors: Dora et al and Cyteval et al reported that an anterior cup prominence between 5.8 and 12 mm is necessary, but not sufficient, to cause iliopsoas impingement on the acetabular component [ 3 , 4 ].…”