W Guicherd1, N Bonin2, T Gicquel3, J E Gedouin4, X Flecher5, M Wettstein6, M Thaunat7, N Prevost8, E Ollier9, O May10. 1. Lyon Ortho Clinic, clinique de la Sauvegarde, 29B, avenue des Sources, 69009 Lyon, France. Electronic address: wguicherd@hotmail.fr. 2. Lyon Ortho Clinic, clinique de la Sauvegarde, 29B, avenue des Sources, 69009 Lyon, France. 3. Service de chirurgie orthopédique et traumatologie, CHU de Rennes, 2, rue Le Guilloux, 35033 Rennes, France. 4. Hôpital privé du confluent, 2-4, rue Eric-Tabarly, 44200 Nantes, France. 5. Hôpital nord, Assistance Publique des Hôpitaux de Marseille, 13000 Marseille, France. 6. ITOLS, clinique de Genolier, route du Muids 3, CH-1272 Genolier, Switzerland. 7. Centre orthopédique Santy, avenue Paul-Santy, 69008 Lyon, France. 8. Clinique du Sport, 4, rue Georges-Negrevergne, 33700 Merignac, France. 9. Inserm, U1059, dysfonction vasculaire et hémostase, 42023 Saint-Etienne, France. 10. Centre de chirurgie de la hanche, médipôle Garonne, 45, rue de Gironis, 31100 Toulouse, France.
Abstract
INTRODUCTION: Impingement between the acetabular component and the iliopsoas tendon is a cause of anterior pain after total hip replacement (THR). Treatment can be non-operative, endoscopic or arthroscopic, or by open revision of the acetabular component. Few studies have assessed these options. The present study hypothesis was that endo/arthroscopic treatment provides rapid pain relief with a low rate of complications. METHODS: A prospective multicenter study included 64 endoscopic or arthroscopic tenotomies for impingement between the acetabular component and the iliopsoas tendon, performed in 8 centers. Mean follow-up was 8months, with a minimum of 6months and no loss to follow-up. Oxford score, patient satisfaction, anterior pain and iliopsoas strength were assessed at last follow-up. Complications and revision procedures were collated. Forty-four percent of patients underwent rehabilitation. RESULTS: At last follow-up, 92% of patients reported pain alleviation. Oxford score, muscle strength and pain in hip flexion showed significant improvement. The complications rate was 3.2%, with complete resolution. Mean hospital stay was 0.8 nights. In 2 cases, arthroscopy revealed metallosis, indicating revision of the acetabular component. The only predictive factor was acetabular projection on oblique view. Rehabilitation significantly improved muscle strength. CONCLUSION: Endoscopic or arthroscopic tenotomy for impingement between the acetabular component and the iliopsoas tendon following THR significantly alleviated anterior pain in more than 92% of cases. The low complications rate makes this the treatment of choice in case of failure of non-operative management. Arthroscopy also reorients diagnosis in case of associated joint pathology. Projection of the acetabular component on preoperative oblique view is the most predictive criterion, guiding treatment.
INTRODUCTION: Impingement between the acetabular component and the iliopsoas tendon is a cause of anterior pain after total hip replacement (THR). Treatment can be non-operative, endoscopic or arthroscopic, or by open revision of the acetabular component. Few studies have assessed these options. The present study hypothesis was that endo/arthroscopic treatment provides rapid pain relief with a low rate of complications. METHODS: A prospective multicenter study included 64 endoscopic or arthroscopic tenotomies for impingement between the acetabular component and the iliopsoas tendon, performed in 8 centers. Mean follow-up was 8months, with a minimum of 6months and no loss to follow-up. Oxford score, patient satisfaction, anterior pain and iliopsoas strength were assessed at last follow-up. Complications and revision procedures were collated. Forty-four percent of patients underwent rehabilitation. RESULTS: At last follow-up, 92% of patients reported pain alleviation. Oxford score, muscle strength and pain in hip flexion showed significant improvement. The complications rate was 3.2%, with complete resolution. Mean hospital stay was 0.8 nights. In 2 cases, arthroscopy revealed metallosis, indicating revision of the acetabular component. The only predictive factor was acetabular projection on oblique view. Rehabilitation significantly improved muscle strength. CONCLUSION: Endoscopic or arthroscopic tenotomy for impingement between the acetabular component and the iliopsoas tendon following THR significantly alleviated anterior pain in more than 92% of cases. The low complications rate makes this the treatment of choice in case of failure of non-operative management. Arthroscopy also reorients diagnosis in case of associated joint pathology. Projection of the acetabular component on preoperative oblique view is the most predictive criterion, guiding treatment.
Authors: André Busch; Marcus Jäger; Sascha Beck; Alexander Wegner; Erik Portegys; Dennis Wassenaar; Jens Theysohn; Johannes Haubold Journal: BMC Musculoskelet Disord Date: 2022-06-28 Impact factor: 2.562
Authors: A Zimmerer; M Hauschild; R Nietschke; M M Schneider; G Wassilew; C Sobau; W Miehlke Journal: Arch Orthop Trauma Surg Date: 2020-10-12 Impact factor: 3.067