Iliopsoas impingement after total hip replacement
THE RESULTS OF NON-OPERATIVE MANAGEMENT, TENOTOMY OR ACETABULAR REVISION
C. Dora, MD, PD, Hip Team Leader1; M. Houweling, MD, Orthopedic Surgeon2; P.
Koch, MD, Knee Team Leader1; and R. J. Sierra, MD, Assistant Professor3
1 Department of Orthopedics Balgrist University Hospital, 8008 Zurich,
Switzerland.
2 Orthopedic Department Regionalspital, 9500 Wil, Switzerland.
3 Mayo Clinic 200 First Street SW, Rochester, Minnesota, USA.
We have reviewed a group of patients with iliopsoas impingement after total hip
replacement with radiological evidence of a well-fixed malpositioned or
oversized acetabular component. A consecutive series of 29 patients (30 hips)
was assessed. All had undergone a trial of conservative management with no
improvement in their symptoms. Eight patients (eight hips) preferred continued
conservative management (group 1), and 22 hips had either an iliopsoas tenotomy
(group 2) or revision of the acetabular component and debridement of the tendon
(group 3), based on clinical and radiological findings. Patients were followed
clinically for at least two years, and 19 of the 22 patients (86.4%) who had
surgery were contacted by phone at a mean of 7.8 years (5 to 9)
post-operatively. Conservative management failed in all eight hips. At the final
follow-up, operative treatment resulted in relief of pain in 18 of 22 hips
(81.8%), with one hip in group 2 and three in group 3 with continuing symptoms.
The Harris Hip Score was significantly better in the combined groups 2 and 3
than in group 1. There was a significant rate of complications in group 3. This
group initially had better functional scores, but at final follow-up these were
no different from those in group 2.
Tenotomy of the iliopsoas and revision of the acetabular component are both
successful surgical options. Iliopsoas tenotomy provided the same functional
results as revision of the acetabular component and avoided the risks of the
latter procedure.
