ePoster #901 - ISHA Annual Scientific Meeting 2016

Clinical Outcomes Of Iliopsoas Release And Capsular Plication In Patients With Acetabular Dysplasia: Restoring The Static Stabilizers May Obviate The Need For A Pathologic Dynamic Stabilizer

David E. Hartigan, MD, Westmont, IL UNITED STATES
Itay Perets, MD, Westmont, IL UNITED STATES
Mary R. Close, BS, Westmont, IL UNITED STATES
John P. Walsh, MA, Westmont, IL UNITED STATES
Edwin Chaharbakhshi, BS, Hinsdale, IL UNITED STATES
Benjamin G. Domb, MD, Chicago, IL UNITED STATES

American Hip Institute, Westmont, IL, UNITED STATES

FDA Status Not Applicable

Summary: This study showed that patients with a LCEA < 25 degrees with associated painful iliopsoas snapping can be successfully treated by addressing intra-articular pathology and performing intra-capsular fractional lengthening of the iliopsoas tendon with concomitant capsular plication.

Abstract:
Background: Iliopsoas fractional lengthening in the hip is a successful procedure in alleviating both snapping and pain associated with snapping. Performing iliopsoas lengthening in patients with a lateral center edge angle (LCEA) less than 25 degrees is controversial due to its proposed secondary role as a dynamic stabilizer of the hip. We have proposed a strategy for treatment of this patient population, which includes fractional lengthening of the pathologic snapping iliopsoas tendon, accompanied by augmentation of the static stabilizers of the hip through capsular plication. Purpose/Hypothesis: The purpose of this study is to track patient reported outcomes (PROs) and Tönnis grade preoperatively and at greater than two years postoperatively in a population with a LCEA of less than 25 degrees who underwent iliopsoas fractional lengthening and capsular plication. Methods: Between July 2009 and December 2011, data on hip arthroscopies performed on patients with LCEA <25 degrees with fractional lengthening of the iliopsoas and capsular plication were prospectively collected and retrospectively reviewed. All patients had preoperative and minimum two-year postoperative PROs: mHHS, HOS-ADL, HOS-SSS, and NAHS. VAS and patient satisfaction with surgery (0-10) were also collected. Radiographs were analyzed preoperatively and at latest follow-up for progression of Tönnis grade. Results: Thirty-two patients met criteria and were analyzed. There were four patients who required revision arthroscopy. Of the 28 patients who did not have revision surgery, mHHS, HOS-ADL, HOS-SSS, and NAHS improved from 68.7-83.5, 64.9-86.6, 71.6-86.7, and 52.6-75.8 respectively (p<0.001). The VAS improved from 5.6 preoperatively to 1.9 at latest follow-up (p<0.001). The average patient satisfaction score was 8.0. There was no radiographic progression of Tönnis grade at final follow-up. Conclusions: This study showed that patients with a LCEA < 25 degrees with associated painful iliopsoas snapping can be successfully treated by addressing intra-articular pathology and performing intra-capsular fractional lengthening of the iliopsoas tendon with concomitant capsular plication. Restoring or augmenting the static stabilizers of the hip with capsular plication and labral restoration may obviate the pathologic need for stability from the iliopsoas tendon.