2021 ISAKOS Biennial Congress Paper
Endoscopic Iliopsoas Lengthening For Treatment Of Recalcitrant Iliopsoas Tendinitis After Total Hip Arthroplasty
Marc R. Safran, MD, Prof., Redwood City, CA UNITED STATES
John Carlo Bonano, MD, Los Altos, CA UNITED STATES
Christopher Jamero, MA, ATC, Redwood City, CALIFORNIA UNITED STATES
Nicole Alexandria Segovia, BA, Redwood City, CA UNITED STATES
James I. Huddleston, MD, Redwood City, CA UNITED STATES
Stanford University, Stanford, CALIFORNIA, UNITED STATES
FDA Status Not Applicable
Endoscopic iliopsoas lengthening can successfully treat recalcitrant iliopsoas tendinitis after total hip arthroplasty and factor affecting negative outcomes can be identified pre-operatively
Iliopsoas (IP) tendinitis may cause persistent groin pain after an otherwise successful total hip arthroplasty (THA). It is generally thought to be due to IP impingement upon the acetabular component. Historically, operative treatment involved either open iliopsoas tenotomy or acetabular component revision. We sought to evaluate a single surgeon series of patients treated with endoscopic iliopsoas tenotomy for IP impingement after THA.
At our institution, patients with persistent pain after total hip arthroplasty who had an evaluation ruling out infection, loosening wear and/or instability, who also had pain with resisted hip flexion that was markedly (at least 50%) relieved, even for a short time, from an ultrasound guided anesthetic injection were diagnosed as having iliopsoas tendinitis. A consecutive series of 24 patients with IP impingement after THA were treated with endoscopic iliopsoas lengthening from 2012 to 2020 at a single-center academic institution. Twenty one patients were available for follow up at a mean of 6.9 months (range 1 – 28 months). The primary outcome was the Modified Harris Hip Score (mHHS). Secondary outcomes included International Hip Outcome Tool 12 (iHOT-12), visual analog scale for pain (VAS), patient satisfaction, graded psoas strength, complications, and acetabular component positioning. Paired and two sample t-tests were used for statistical analyses in RStudio version 1.1.456 (Boston, MA) using a two-sided level of significance of 0.05.
The mean mHHS preoperatively was 57.3 (range 35.1 – 81.3, SD 12.2) and postoperatively was 76.3 (range 31 – 100, SD 18.9, p = 0.0001). Significant improvements in mHHS correlated with increased patient satisfaction (p = 0.013) and VAS pain scores of less than 5 (p = 0.027). Clinically meaningful improvements in mHHS were seen in patients with an acetabular cup prominence of >8mm, a BMI of >30, and those who had their index THA within 2 years. At final follow up, 72% of patients were satisfied with their surgery, and satisfaction was associated with improvement in mHHS (p = 0.013) and shorter time from index THA (p = 0.011). One patient developed an infection 7 months postoperatively (felt not to be related to the endoscopic procedure) requiring a two-stage total hip arthroplasty revision, and one patient underwent an open psoas release for persistent pain, yet with only partial relief from each surgery.
Endoscopic IP tenotomy for impingement after THA may be a safe alternative to open tenotomy or acetabular component revision in patients who have failed nonoperative management. Patients can expect high satisfaction and significant improvements in pain and function with low complication rates. Furthermore, we found that those patients with a cup prominence of > 8mm and those treated within 2 years of their index THA were more likely to have greater satisfaction and clinically meaningful improvements in their mHHS.