Jesús Moreta1, Adrián Cuéllar2, Urko Aguirre3, Óscar L Casado-Verdugo4, Alberto Sánchez1, Ricardo Cuéllar2. 1. Group of Lower Limb Reconstructive Surgery, Biocruces Bizkaia Health Research Institute, Department of Orthopaedic Surgery and Trauma, Hospital Galdakao-Usansolo, Galdakao, Spain. 2. Department of Orthopaedic Surgery and Trauma, Donostia Universitary Hospital, San Sebastián, Spain. 3. Research Network on Health Services on Chronic Diseases (REDISSEC), Research Unit, Hospital Galdakao-Usansolo, Galdakao, Spain. 4. Osatek Alta Tecnología Sanitaria S.A., Department of Magnetic Resonance Imaging, Hospital Galdakao-Usansolo, Galdakao, Spain.
Abstract
PURPOSE: 1 of the causes of groin pain after total hip arthroplasty (THA) is impingement of the iliopsoas tendon. The purpose of this study was to present our results with outside-in arthroscopic tenotomy for iliopsoas impingement after THA. METHODS: We retrospectively reviewed 12 patients treated between 2009 and 2016 with a minimum follow-up of 2 years. Anterior acetabular component prominence was measured on a true lateral hip radiograph. A transcapsular tenotomy was performed near the edge of the acetabular component through an outside-in arthroscopic approach. The primary clinical outcomes evaluated were groin pain, assessed with a visual analogue scale (VAS), and the Harris Hip Score (HHS). Secondary outcomes included strength of hip flexion, measured with the Medical Research Council (MRC) scale. RESULTS: All patients had groin pain improvement, though one patient continued to have moderate pain. The mean VAS score was significantly lower postoperatively (1.08) than preoperatively (6.2) (p < 0.001). The mean HHS improved from 58.8 (range, 37-76) to 86.1 (range, 59-98) (p = 0.001). The average postoperative MRC Scale was 4.58. The mean anterior prominence was 7.25 mm (range 3-12 mm). In patients with <10 mm of component prominence, tenotomy provided groin pain resolution in all cases (n = 8). In patients with ⩾10 mm of prominence, symptoms resolved in 3 out of 4 cases. CONCLUSIONS: Outside-in arthroscopic iliopsoas release provided a high rate of success with no complications in this study, even in patients with moderate acetabular component prominence.
PURPOSE: 1 of the causes of groin pain after total hip arthroplasty (THA) is impingement of the iliopsoas tendon. The purpose of this study was to present our results with outside-in arthroscopic tenotomy for iliopsoas impingement after THA. METHODS: We retrospectively reviewed 12 patients treated between 2009 and 2016 with a minimum follow-up of 2 years. Anterior acetabular component prominence was measured on a true lateral hip radiograph. A transcapsular tenotomy was performed near the edge of the acetabular component through an outside-in arthroscopic approach. The primary clinical outcomes evaluated were groin pain, assessed with a visual analogue scale (VAS), and the Harris Hip Score (HHS). Secondary outcomes included strength of hip flexion, measured with the Medical Research Council (MRC) scale. RESULTS: All patients had groin pain improvement, though one patient continued to have moderate pain. The mean VAS score was significantly lower postoperatively (1.08) than preoperatively (6.2) (p < 0.001). The mean HHS improved from 58.8 (range, 37-76) to 86.1 (range, 59-98) (p = 0.001). The average postoperative MRC Scale was 4.58. The mean anterior prominence was 7.25 mm (range 3-12 mm). In patients with <10 mm of component prominence, tenotomy provided groin pain resolution in all cases (n = 8). In patients with ⩾10 mm of prominence, symptoms resolved in 3 out of 4 cases. CONCLUSIONS: Outside-in arthroscopic iliopsoas release provided a high rate of success with no complications in this study, even in patients with moderate acetabular component prominence.
Entities:
Keywords:
Arthroscopic tenotomy; hip arthroscopy; iliopsoas impingement; iliopsoas tendinitis; iliopsoas tenotomy; total hip replacement
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