Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Feb;142(2):189-195.
doi: 10.1007/s00402-020-03623-z. Epub 2020 Oct 12.

Results after arthroscopic treatment of iliopsoas impingement after total hip arthroplasty

A Zimmerer  1   2 , M Hauschild  3 , R Nietschke  3 , M M Schneider  3   4 , G Wassilew  5 , C Sobau  3 , W Miehlke  3
Affiliations

Results after arthroscopic treatment of iliopsoas impingement after total hip arthroplasty

A Zimmerer et al. Arch Orthop Trauma Surg. 2022 Feb.

Erratum in

Abstract

Background: A cause of groin pain after total hip arthroplasty (THA) is mechanical irritation or impingement of the iliopsoas tendon. The incidence is about 4%. If conservative therapy fails, an arthroscopic release of the iliopsoas tendon can be performed. The aim of the study was to assess the mid-term clinical outcome after arthroscopic release. We hypothesize that good results can be achieved by a minimally invasive endoscopic procedure.

Methods: Using our in-house database, all patients who received an endoscopic release of the iliopsoas tendon due to mechanical irritation after THA were identified. Inclusion criteria were mechanical irritation of the iliopsoas tendon after cementless THA with minimal acetabular component prominence. Exclusion criteria were marked prominence of the acetabular component and groin pain after THA for any other reason. In these patients, the modified Harris Hip Score (mHHS), the pain level using the numerical analogue scale and the UCLA Activity Score were measured. The mean follow-up period was 7 ± 3.8 (2.6-11.7) years.

Results: 25 patients were identified in whom an arthroscopic release of the iliopsoas tendon had been performed since 2007. The data of 20 patients were available at follow-up. The gender ratio was 1:1, the average age at the time of arthroscopy was 59 ± 27.7 (52-78) years. The average interval between THA and arthroscopy was 6.3 ± 4.0 (1.7-15) years. The mHHS showed a significant improvement from preoperative 31.2 ± 9.8 (17.6-47.3) to 82.0 ± 9.8 (46.2-100) points (p = 0.001). The pain level on the NAS decreased significantly from 8.5 ± 1.2 (7-10) to 2.5 ± 1.8 (0-6) points (p = 0.001). The activity level based on the UCLA Activity Score raised from 4.0 ± 2.7 (0-7) to 6.5 ± 1.8 (3-9) (p = 0.09).

Conclusion: Mechanical irritation and impingement of the iliopsoas tendon is an important diagnosis to be considered in persistent groin pain after total hip arthroplasty. In failure of non-operative treatment, good clinical results can be achieved with arthroscopic release and the pain level can be significantly reduced.

Level of evidence: IV.

Keywords: Complication; Hip prosthesis; Iliopsoas tendon; Outcome; Revision hip surgery; Total hip replacement.

PubMed Disclaimer

Conflict of interest statement

One or more author received personal fees from Richard Wolf, Arthrex, DePuy Synthes or Waldemar Link.

Figures

Fig. 1
Fig. 1
Axial CT scan of a right hip, red arrow: prominent acetabular cup; yellow circle: iliopsoas tendon irritated by acetabular cup prominence
Fig. 2
Fig. 2
Left: arthroscopic view onto a left hip prosthesis, the iliopsoas tendon is irritated by the acetabular component; right: situation after arthroscopic tenotomy using a radiofrequency device. T tendon, C capsule, AC acetabular component
See this image and copyright information in PMC

References

    1. (2013) 90-day mortality after 409 096 total hip replacements for osteoarthritis, from the National Joint Registry for England and Wales: a retrospective analysis. The Lancet 382(9898):1097–1104 - PubMed
    1. Duffy P, Masri BA, Garbuz D, et al. Evaluation of patients with pain following total hip replacement. Instr Course Lect. 2006;55:223–232. - PubMed
    1. Morrey BF, Adams RA, Cabanela ME. Comparison of heterotopic bone after anterolateral, transtrochanteric, and posterior approaches for total hip arthroplasty. Clin Orthop Relat Res. 1984;188:160–167. - PubMed
    1. Postel M. Les prothèses douloureuses (painful prosthesis. I. Possible causes) Rev Chir Orthop Reparatrice Appar Mot. 1975;61(Suppl 2):57–61. - PubMed
    1. Ala Eddine T, Remy F, Chantelot C, et al. Douleur inguinale isolée après prothèse totale de hanche et souffrance de l'ilio-psoas (Anterior iliopsoas impingement after total hip arthroplasty: diagnosis and conservative treatment in 9 cases) Rev Chir Orthop Reparatrice Appar Mot. 2001;87(8):815–819. - PubMed