Paper #36 - ISHA Annual Scientific Meeting 2016

Endoscopic Treatment of Psoas Impingement after Total Hip Arthroplasty : Minimum 2 Year Follow Up

Suenghwan Jo, MD, PhD, Gwangju SOUTH KOREA
John M. O'Donnell, MBBS, FRACS, FAOrthA, Hawthorn, VIC AUSTRALIA

Hip Arthroscopy Australia, Melbourne, VIC, AUSTRALIA

FDA Status Not Applicable

Summary: Endoscopic iliopsoas release can alleviate painful snapping after total hip arthroplasty but the procedure may develop postoperative hip flexion weakness leading to low satisfaction rate.

Introduction : This study reports the outcome of endoscopic ilipsoas release to treat psoas impingement that developed after total Hip arthroplasty.

Materials and Methods : The study comprised of 18 patients who developed iliopsoas impingement after total hip arthroplasty. In all patients, the painful clicking of the hip did not respond to non-operative treatment and endoscopic iliopsoas release was performed between May, 2008 and October, 2013. The mean age of the subjects were 64.7 years at the time of the surgery and included 6 males and 12 females. The initial symptom developed within in 1 month from the index hip arthoplasty in 10 patients, within 6 months in 7 patients and more than 1 year in 1 patients. Retrospective review of prospectively collected data of clinical outcomes including modified Harris hip score and non-arthritic hip were performed with mean latest follow up of 49 months (range 24 to 84 months).

Results : Two patients underwent subsequent hip arthroplasty for the reason unrelated to the psoas impingement. The initial improvement of painful snapping was seen in all patients. Immediate postoperative hip flexion weakness was developed in 6 patients which was not recovered in 3 patients. At the last follow up, the mean Harris hip score was improved by 12.4 and non-arthritic hip score by 10.2. However, while 80% replied the initial symptom has improved after the operation, only 50% of the patients were satisfied with the operation. Four patient developed recurrent painful snapping, 2 of which were treated with additional endoscopic procedure.

Conclusions : Despite efficacy of endoscopic iliopsoas release to alleviate painful snapping after total hip arthroplasty, the satisfaction rate was low due to high prevalence of developing hip flexion weakness.