Summary: Endoscopic iliopsoas lengthening can successfully treat recalcitrant iliopsoas tendinitis after total hip arthroplasty and factor affecting negative outcomes can be identified pre-operatively

Purpose

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.

Methods

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.

Results

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.

Conclusion

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.

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Arthroscopic Tendon Release for Iliopsoas Impingement after Total Hip Arthroplasty ePoster Presentation Michael Andreas Finsterwald, MD, AUSTRALIA Georgina Waters, MD, AUSTRALIA Jay R. Ebert, PhD, AUSTRALIA Christopher W. Jones, FAOrthA FRACS PhD MBBS(Hons) BEng(Hons) BCom, AUSTRALIA Piers Yates, MBBS(Hons) BSc(Hons) MRCS(Eng) FRCS(Tr & Orth) FRA, AUSTRALIA Peter Alberto D'Alessandro, MBBS Hons. (UWA) FRACS FAOrthA, AUSTRALIA
Similar Joint Space Measurements Are Obtained With Supine And Weightbearing Anteroposterior Pelvis Radiographs: Results Of A Prospective Study Abstract Presentation 5 minutes Blake M. Bodendorfer, MD, UNITED STATES Vishal A. Mehta, DO, UNITED STATES Austin M Looney, MD, UNITED STATES Kenneth Tepper, MD, UNITED STATES
Effect Of Femoral And Acetabular Version On Outcomes Following Hip Arthroscopy: A Systematic Review And Meta-Analysis Abstract Presentation 9 minutes Casey Wang, MD, CANADA Dan Cohen, MD, CANADA Jeffrey Kay, MD, CANADA Mahmoud Almasri, MD, FRCSC, UNITED STATES Nicole Simunovic, MSc, CANADA Carlomagno Cardenas-Nylander, MD, SPAIN Anil S. Ranawat, MD, UNITED STATES Olufemi R. Ayeni, MD, PhD, MSc, FRCSC, CANADA
Hip Labrum Reconstruction With A Polyurethane Scaffold: A Preliminary Report Of 3 Cases ePoster Presentation Bruno Capurro, MD, PhD., SPAIN Marc Tey, MD, PhD., SPAIN Raul Torres, MD, SPAIN Fernando Marques, MD, PhD., SPAIN Alfonso León, MD, PhD., SPAIN Oliver Marín-Peña, MD, SPAIN Joan Carles Monllau, MD, PhD, Prof., SPAIN
Predicting Dissatisfaction Following Total Hip Arthroplasty Using A Bayesian Model Averaging (Bma) Approach: Results From The Australian Arthroplasty Clinical Outcomes Registry (Acorn) ePoster Presentation Jan Peter Van Meirhaeghe, MD, BELGIUM Rob Molnar, MBBS, AUSTRALIA Sam Adie, BSc(Med) MBBS MSpMed MPH PhD FRACS, AUSTRALIA
Hip Arthroscopy in Patients with Borderline Dysplasia. ePoster Presentation Leonel Perez Alamino, MD, ARGENTINA Daniel Fernando Veloz Serrano, Md, ARGENTINA Agustin Felipe Catan, MD, ARGENTINA Tomas Rafael Vilaseca, MD, ARGENTINA
Outcome Measures After Proximal Hamstring Repair: A Systematic Review ePoster Presentation Tara Reza, MPH, UNITED STATES Andre Gordon Perez-Chaumont, BS, UNITED STATES Andrew J Hinkle, BS, UNITED STATES Symone M Brown, MPH, UNITED STATES Mary K. Mulcahey, MD, UNITED STATES
Does MRI Scan Enable Optimally Informed Pre-Operative Planning In Hip Arthroscopy? Abstract Presentation 5 minutes Vitali Goriainov, FRCS (Orth), BM, PhD, MSc, UNITED KINGDOM Fadi Hindi, BM, MRCS, UNITED KINGDOM Andrew Langdown, BSc MB ChB FRCS(Tr&Orth), UNITED KINGDOM
Can Hip Pain Be Treated With Tibial Malrotation Correction? Abstract Presentation 5 minutes Vitali Goriainov, FRCS (Orth), BM, PhD, MSc, UNITED KINGDOM Mohamed Zubair Farook, MBBS, D.Ortho, FRCS (Orth), UNITED KINGDOM Rajiv Kaila, MRCS, MSc, MFSEM(UK), FEBOT, UNITED KINGDOM Tom CB Pollard, MD, FRCS (Tr & Orth), UNITED KINGDOM Antonio J. M. D. Andrade, MB BS, M.Sc., FRCS(Tr&Orth), UNITED KINGDOM
Cleft Sign and Bone Marrow Edema of the Pubic Synthesis are Associated with Sports Activity and Bony Morphology Related to Femoroacetabular Impingement in Symptomatic Patients with Labral Tears: A Cohort Study Abstract Presentation 5 minutes Keisuke Nakayama, MD, PhD, JAPAN Hajime Utsunomiya, MD, PhD, JAPAN Soshi Uchida, MD, PhD, JAPAN
Outcomes of Associated Both Column Acetabular Fractures with and without a Posterior Wall Fracture ePoster Presentation George Bradley Reahl, MS, UNITED STATES Michael McTague, MPH, UNITED STATES Nishant Suneja, MD, UNITED STATES Arvind Von Keudell, MD, UNITED STATES
Hip Arthroscopic Portals:A New Approach Through Accessory Portals Established Within 3Cm Around Anterolateral Portal ePoster Presentation Kiran Kumar Shah, MD, NEPAL
The Relationship Between Early And Mid-Term Hip Arthroscopy Outcomes: Employing 3 Month Follow-Up To Predict Mid-Term Results Abstract Presentation 5 minutes Mario Hevesi, MD, PhD, UNITED STATES Ajay C. Lall, MD, MS, FAAOS, UNITED STATES David E. Hartigan, MD, UNITED STATES Bruce A. Levy, MD, UNITED STATES Benjamin G. Domb, MD, UNITED STATES Aaron J. Krych, MD, UNITED STATES
Endoscopic Shelf Acetabuloplasty Concomitant With Labral Repair, Cam Osteoplasty, And Capsular Plication For Treating Artistic Dancers In The Setting Of Acetabular Dysplasia: A Case Series Abstract Presentation 4 minutes Soshi Uchida, MD, PhD, JAPAN Yoichi Murata, MD, JAPAN Hajime Utsunomiya, MD, PhD, JAPAN Tsukamoto Manabu, MD, PhD, JAPAN Akihisa Hatakeyama, MD, JAPAN Shiho Kanezaki, MD, PhD, JAPAN Akinori Sakai, MD, PhD, JAPAN

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Endoscopic Iliopsoas Lengthening For Treatment Of Recalcitrant Iliopsoas Tendinitis After Total Hip Arthroplasty

Endoscopic Iliopsoas Lengthening For Treatment Of Recalcitrant Iliopsoas Tendinitis After Total Hip Arthroplasty

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Endoscopic Iliopsoas Lengthening For Treatment Of Recalcitrant Iliopsoas Tendinitis After Total Hip Arthroplasty

Endoscopic Iliopsoas Lengthening For Treatment Of Recalcitrant Iliopsoas Tendinitis After Total Hip Arthroplasty

Purpose

Methods

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