Pain related to the psoas muscle after total hip replacement

Abstract

R esidual pain after total hip replacement may be due to a number of causes both local to and distant from the hip. We describe pain related to the psoas muscle after total hip replacement in nine patients. All presented with characteristic symptoms. We describe the key features and management. Gratifying results were achieved with treatment. This diagnosis should be considered when assessing patients with pain after total hip replacement.J Bone Joint Surg [Br] 2002;84-B:991-3.

Incidence of Groin Pain After Metal-on-Metal Hip Resurfacing

“…Hence, a prominent acetabular cup (ie, where the anterior rim of the acetabular component extends beyond the anterior rim of the osseous acetabulum) or osteophytes on the preserved anterior neck may cause irritation of the iliopsoas tendon sheath, leading to a clinical presentation of anterior groin pain. These findings have been confirmed after THA in studies that included histologic examination of the psoas tendon at these sites [29]. The diagnosis of iliopsoas tendonitis is also made by local anesthetic/corticosteroid injection into the psoas tendon under radiographic guidance.…”

“…This diagnosis is made clinically by the pain pattern, which usually involves pain on resisted leg raise, groin pain when getting up from a seated position, and the ''car sign'' [29]. Indeed, although the exact etiology of groin pain after THA is most likely multifactorial, iliopsoas tendonitis secondary to acetabular component malposition and/or uncoverage [17,36,42] has been one of the most commonly identified causes.…”

“…Consequently, patients undergoing hip resurfacing may be predisposed to persistent groin pain due to insufficient head/neck offset, an uncovered acetabular component, or a combination of both. Despite the potential for an increased incidence of groin pain or psoas tendonitis after hip resurfacing the incidence of groin pain has not been reported in large series, although the incidence after conventional THA ranges between 0.3% and 4.3% [10,29,36].…”

The Durom Large Diameter Head acetabular component

“…The management of iliopsoas impingement whether by infiltration, tenotomy, or prosthesis exchange) remains controversial. 50,51,[53][54][55] Prevention remains the best treatment: sufficient acetabular component anteversion prevents protrusion of its anterior rim: excessive opening of the component should also be avoided.…”

Diagnostic and Therapeutic Use of Sonography-Guided Iliopsoas Peritendinous Injections

“…Problems may occur when inflammation of the tendon is present or if bursitis exists between the tendon and the pelvis or anterior hip capsule [1,2]. Iliopsoas irritation may also occur after total hip arthroplasty, especially if a prominent socket impinges on the tendon [3,5,6,10].…”