Risk factors for iliopsoas impingement after total hip arthroplasty using a collared femoral prosthesis

Abstract

Background The relationship between collar design of a femoral component and iliopsoas impingement (IPI) after total hip arthroplasty (THA) is still underrecognized. The purpose of our study was to determine the possible risk factors for IPI related to the femoral component, when using a collared femoral prosthesis. Methods A total of 196 consecutive THA patients (206 hips) using a collared femoral prosthesis were reviewed retrospectively after exclusion of the factors related to acetabular component and femoral head. The patients were divided into +IPI and −IPI group according to the presence of IPI. Radiological evaluations were performed including femoral morphology, stem positioning, and collar protrusion length (CPL). Multivariate regression analysis was performed to assess the risk factors for IPI. Results At a minimum follow-up of 1 year, IPI was observed in 15 hips (7.3%). Dorr type C proximal femur was found in nine hips (60%) in the +IPI group and in 28 hips in the −IPI group (14.7%, p < 0.001). The mean stem anteversion in the +IPI group was significantly greater than that in the −IPI group (19.1° vs. 15.2°, p < 0.001), as well as the mean CPL (2.6 mm vs. − 0.5 mm, p < 0.001). The increased stem anteversion ( OR = 1.745, p = 0.001) and CPL ( OR = 13.889, p = 0.001) were potential risk factors for IPI. Conclusions The incidence of IPI after THA is higher than expected when using a collared femoral prosthesis. Among the factors related to collared femoral prosthesis, excessively increased stem anteversion and prominent collar protrusion are independent predictors for IPI. In addition, high risk of IPI should be carefully considered in Dorr type C bone, despite that femoral morphology is not a predictive factor. Level of evidence Level IV, clinical cohort study

Impact of Femoral Stem Prosthesis Tip On Femoral Cortex After Primary Total Hip Arthroplasty (THA)

“…[10,17] Although the conical femoral stem prosthesis could reduce the pain occurrence, it still has a high incidence due to unknown mechanisms. [18,19] At present, researches on impact after THA between prosthesis, strikes and iliopsoas muscle (between the bones and abundant) [20][21][22][23], and those on the implant tip and femoral cortical impact, mainly focus on the intramedullary nail surgery. However, few studies have focused on the femoral prosthesis stem tip and femoral cortical impact problems after THA.…”

Survival analysis for all-cause revision following primary total hip arthroplasty with a medial collared, triple-tapered primary hip stem versus other implants in real-world settings

“…However, the collar may also limit the degree of press-fit fixation, that could result in failure or calcar impingement in cases of stem subsidence. 15,16,23 Although there is limited direct comparative literature on the benefits of collared stems, some studies and national registries have shown that the collared stem lowered the risk of loosening or fracture when compared to the collarless stem. 24 The MCTT primary hip stem incorporates design features from a number of clinically established hip systems, including CORAIL, SUMMIT and TRI-LOCK.…”

“…This study evaluated the risk of all-cause revisions only and did not analyze specific cause for revisions. Future studies could focus on specific cause for revisions, other complications associated with the components of the THA, such as collar 23 and follow patients over longer terms post THA.…”

Editorial Commentary: The Cause of Groin Pain Is Difficult to Determine: The Elusive “Nether-Nether Region”

“…If the patient has recently undergone total hip arthroplasty, one should consider whether the components, and especially the acetabular cup, are malpositioned or if the stem has a collar that both could rub on the tendon at the anterior margin of the acetabulum or calcar respectively. [8][9][10][11] Importantly, one would want to rule out other causes of persistent hip pain after total joint arthroplasty such as infection, loose prostheses, or metallosis. In the native hip, the iliopsoas has been found to be a cause of acetabular labral pathology, especially in the setting of mild or borderline dysplasia, microinstability, and ligamentous laxity and increased femoral anteversion.…”