Iliopsoas bursa injections can be beneficial for pain after total hip arthroplasty

Abstract

Impingement of the iliopsoas tendon is an uncommon cause of groin pain after total hip arthroplasty (THA). We asked whether selective steroid and anesthetic injections for iliopsoas tendonitis after THA would relieve pain and improve function. We retrospectively reviewed 27 patients with presumed iliopsoas tendinitis treated by fluoroscopically guided injections of the iliopsoas bursa. Pre- and immediately postinjection, questionnaires and telephone followup questionnaires were administered to determine patient outcomes. Four patients were lost to followup and we were unable to obtain information from relatives on an additional four; the questionnaire was administered to the remaining 19 patients, including six who subsequently had surgery at an average of 44.6 months (range, 25-68 months) after their first injection. The average modified Harris hip score in the 19 patients improved from 61 preinjection to 82 postinjection and the average pain improved from 6.4 preinjection to 2.9 postinjection, but eight patients (30%) required a second injection at an average of 8.2 months after the first injection. Ultimately, six patients (22%) had an additional surgical procedure to address the underlying cause of the iliopsoas irritation. Iliopsoas tendonitis is uncommon after THA but should be considered in the differential diagnosis of all patients who present with groin pain after THA. Selective steroid and anesthetic injections of the iliopsoas bursa give adequate pain relief in the majority of patients and should be considered part of the nonoperative treatment plan before surgical release of the iliopsoas tendon or component revision.

Level of evidence: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Fig. 1A–B

(A) The frontal view is shown with slight right posterior obliquity, with early deposit of contrast. Arrows outline the contrast. The needle tip is placed over the midportion of the acetabular component superiorly and is lateral to the femoral artery. (B) With about 30° of right posterior obliquity, a few seconds later with more contrast deposited (arrows) the contrast passes from the edge of the acetabular component cephalad into the iliac fossa.

Fig. 2A–B

(A) Anteroposterior radiograph of a 76-year-old man who had THA performed on his left hip 1.5 years before developing iliopsoas tendonitis pain. The acetabular inclination is 32°. (B) Crosstable lateral radiograph shows the acetabular component with 14° of anteversion and 6.5 mm of bony uncoverage along the anterior rim.