C Batailler1, N Bonin2, A Nogier3, S Martres4, E Ollier5, O May6, S Lustig7. 1. Centre Albert-Trillat, groupement hospitalier Nord, 103, grande rue de la Croix-Rousse, 69004 Lyon, France. Electronic address: cecile-batailler@hotmail.fr. 2. Lyon Ortho Clinic, 29B, avenue des Sources, 69009 Lyon, France. 3. Nollet Institute, 23, rue Brochant, 75017 Paris, France. 4. Orthopaedic Department, Hôpital Renée-Sabran, boulevard Edouard-Herriot, 83406 Hyères, France. 5. U1059, Inserm, dysfonction vasculaire et hémostase, 42023 Saint-Etienne, France. 6. Centre de chirurgie de la hanche, Médipôle Garonne, 45, rue de Gironis, 31100 Toulouse, France. 7. Centre Albert-Trillat, groupement hospitalier Nord, 103, grande rue de la Croix-Rousse, 69004 Lyon, France.
Abstract
BACKGROUND: Impingement of the ilio-psoas tendon on the acetabular component is a cause of pain after total hip arthroplasty (THA). Studies of cup revision for ilio-psoas impingement (IPI) are scarce and limited in size. We therefore conducted a large multicentre retrospective study with the following objectives: to assess the effectiveness of cup replacement in resolving the impingement syndrome, to determine the frequency and nature of complications after cup revision for IPI, and to identify pre-operative factors associated with good outcomes of cup revision for IPI. HYPOTHESIS: Cup revision is effective in resolving the pain due to IPI in selected patients. METHODS: This retrospective multicentre study included 46 patients who underwent cup revision because of IPI. Before the revision, 38 (83%) patients had prominence of the anterior cup rim (mean, 9.9±4.5mm (range, 2-22mm) by radiography and 35 (76%) had cup malposition (anteversion<10° and/or inclination>50°). Mean follow-up was 21months (range, 6months to 6 years) and no patient was lost to follow-up. Outcomes at last follow-up were assessed based on the Oxford Hip Score (OHS), patient satisfaction index, complications, and revisions. RESULTS: At last follow-up, 39 (85%) patients were satisfied with the revision procedure, a significant improvement versus baseline was noted in the OHS (mean, 43±6; range, 25-48; P<0.001), and 41 patients were free of pain during hip flexion (P<0.001 versus baseline). Complications occurred in 3 (6.5%) patients, but only one complication was severe (deep infection). Recurrent groin pain was reported by 4 (8.7%) patients at last follow-up. None of the factors studied predicted the outcome of revision surgery. DISCUSSION: Cup revision for IPI after THA is effective in relieving the groin pain in 80% of patients with anterior cup rim prominence and/or cup malposition. However, complications can occur. Tenotomy may be preferable when the diagnosis is in doubt and/or cup position is acceptable. LEVEL OF EVIDENCE: IV, retrospective observational study. Published by Elsevier Masson SAS.
BACKGROUND: Impingement of the ilio-psoas tendon on the acetabular component is a cause of pain after total hip arthroplasty (THA). Studies of cup revision for ilio-psoas impingement (IPI) are scarce and limited in size. We therefore conducted a large multicentre retrospective study with the following objectives: to assess the effectiveness of cup replacement in resolving the impingement syndrome, to determine the frequency and nature of complications after cup revision for IPI, and to identify pre-operative factors associated with good outcomes of cup revision for IPI. HYPOTHESIS: Cup revision is effective in resolving the pain due to IPI in selected patients. METHODS: This retrospective multicentre study included 46 patients who underwent cup revision because of IPI. Before the revision, 38 (83%) patients had prominence of the anterior cup rim (mean, 9.9±4.5mm (range, 2-22mm) by radiography and 35 (76%) had cup malposition (anteversion<10° and/or inclination>50°). Mean follow-up was 21months (range, 6months to 6 years) and no patient was lost to follow-up. Outcomes at last follow-up were assessed based on the Oxford Hip Score (OHS), patient satisfaction index, complications, and revisions. RESULTS: At last follow-up, 39 (85%) patients were satisfied with the revision procedure, a significant improvement versus baseline was noted in the OHS (mean, 43±6; range, 25-48; P<0.001), and 41 patients were free of pain during hip flexion (P<0.001 versus baseline). Complications occurred in 3 (6.5%) patients, but only one complication was severe (deep infection). Recurrent groin pain was reported by 4 (8.7%) patients at last follow-up. None of the factors studied predicted the outcome of revision surgery. DISCUSSION: Cup revision for IPI after THA is effective in relieving the groin pain in 80% of patients with anterior cup rim prominence and/or cup malposition. However, complications can occur. Tenotomy may be preferable when the diagnosis is in doubt and/or cup position is acceptable. LEVEL OF EVIDENCE: IV, retrospective observational study. Published by Elsevier Masson SAS.
Entities:
Keywords:
Acetabular revision; Complication; Ilio-psoas impingement; Total hip arthroplasty
Authors: Alexandra I Stavrakis; Amir Khoshbin; Amethia Joseph; Lily Y Lee; Mathias P Bostrom; Geoffrey H Westrich; Alexander S McLawhorn Journal: HSS J Date: 2020-08-04
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