Paper #67 - ISHA Annual Scientific Meeting 2016

Clinical Outcomes and Complications of Arthroscopic Release for Iliopsoas Impingement after Total Hip Arthroplasty

Seung-Min Choi, MD, Jeonju SOUTH KOREA
Sun-Jung Yoon, MD, PhD, Jeonju SOUTH KOREA
Myung Sik Park, Prof., Jeonju, Chonbuk SOUTH KOREA
Bareunchan Ju, MD, Jeonju SOUTH KOREA

Chonbuk National University Hospital, Jeonju, SOUTH KOREA

FDA Status Not Applicable

Summary: Arthroscopic release of the iliopsoas tendon with evidence of iliopsoas impingement after THA gives relatively good clinical results, however, anterior dislocation of total hip replacement can be occurred in the patient who had inappropriate cup position especially in dysplastic hip with severe degree of posterior pelvic tilt and small femoral head.

Abstract:
Introduction
Anterior iliopsoas impingement and tendinitis may be present after total hip arthroplasty. The purpose of the study was to present clinical results and complications of arthroscopic treatment in patient with iliopsoas impingement syndrome after a total hip arthroplasty.
Materials and Methods
We performed 20 arthroscopic release of iliopsoas tendon in consecutive patients with groin pain after total hip arthroplasty, with a minimum 2-year follow-up. All patients underwent conservative treatment for at least 6 months without success. The indication for the arthroscopic procedure was the failure of the conservative therapy as well as typical clinical signs as painful flexion, a positive local anesthesia test or radiological evidence of the presence of a prominent anterior acetabular component. Data retrospectively collected for all patients regarding the resolution or persistence of groin pain. Patients were assessed preoperatively and postoperatively using the following patient-satisfaction scale (0-5), modified Harris Hip Score (mHHS), and visual analog scale (VAS).
Results
A total of 20 hips were included, with all mHHS showing statistically significant improvement postoperatively (67.3 ± 15.4 preoperatively vs 85.3 ± 19.1 at 2 years) (P < .001). Seventeen patients (85%) reported good/excellent satisfaction (4=). Overall, 18 patients (85%) reported resolution of painful hip flexion. One patient complaint persistence of residual groin pain at a 2 years. Recurrent anterior dislocation occurred in one patient after arthroscopic IP release, who has 20 degree posterior pelvic tilt and malpositioned cup. Acetabular revision was required eventually to stabilize the THA.
Conclusion
Arthroscopic release of the iliopsoas tendon with evidence of iliopsoas impingement after total hip replacement gives relatively good clinical results. Anterior dislocation of total hip replacement can be occurred in the patient who had inappropriate cup position especially in dysplastic hip with severe degree of posterior pelvic tilt and small femoral head.