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. 2019 May 22;14(1):145.
doi: 10.1186/s13018-019-1176-z.

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

Junfeng Zhu  1 , Yang Li  1 , Kangming Chen  2 , Fei Xiao  1 , Chao Shen  1 , Jianping Peng  1 , Xiaodong Chen  3
Affiliations

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

Junfeng Zhu et al. J Orthop Surg Res. .

Abstract

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.

Keywords: Hip dysplasia; Hip instability; Iliopsoas tendonitis; Total hip arthroplasty.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Radiographs of a 45-year-old woman are shown with right hip replacement for treating severe osteoarthritis. Dysplastic right hip with severe osteoarthritis was shown on the preoperative radiograph (a). Bilateral leg lengths were equal on the radiograph (b) at 1 month postoperatively. No complication was found until severe groin pain was complained at 5 months postoperatively. The swelling iliopsoas muscle (white arrow) was indicated on the anteroposterior radiograph (c) of 5 months postoperatively. d Computed tomographic scans of the painful hip at 5 months postoperatively. The enlarged iliopsoas (white arrow) with abnormal signal density was adhered to the thickened anterior capsule (white long arrow). e An over-anteverted acetabular component was detected on the computed tomographic scan at the level of acetabular component
Fig. 2
Fig. 2
Hip revision in the foregoing patient at 6 months postoperatively. A securely fixed acetabular component was confirmed during the revision surgery. Bone ingrowth was shown within the surface of acetabular component (a). b A trabecular metal acetabular component with decreased anteversion was shown on the radiograph after hip revision
See this image and copyright information in PMC

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