Results after arthroscopic treatment of iliopsoas impingement after total hip arthroplasty
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ORTHOPAEDIC SURGERY
Results after arthroscopic treatment of iliopsoas impingement after total hip arthroplasty A. Zimmerer1,2 · M. Hauschild1 · R. Nietschke1 · M. M. Schneider1,3 · G. Wassilew2 · C. Sobau1 · W. Miehlke1 Received: 24 May 2020 / Accepted: 30 September 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
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 Total hip replacement · Iliopsoas tendon · Revision hip surgery · Complication · Outcome · Hip prosthesis
Background
* A. Zimmerer [email protected] 1
ARCUS Sportklinik, Rastatterstr. 17‑19, 75179 Pforzheim, Germany
2
Department of Orthopedics and Orthopedic Surgery, University Medicine Greifswald, Ferdinand‑Sauerbruch‑Straße, 17475 Greifswald, Germany
3
University of Witten/Herdecke, Alfred‑Herrhausen‑Straße 50, 58455 Witten, Germany
The majority of patients after total hip arthroplasty (THA) are very satisfied with the result achieved [1]. However, there are pati
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