Updated: 2/8/2017

THA Iliopsoas Impingement

Topic
Review Topic
0
0
Questions
2
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0
Evidence
3
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0
Introduction
  • Underrecognized cause of recurrent groin pain after total hip replacement
  • May be caused by
    • retained cement
    • malpositioned acetabular component
    • limb length discrepancy
    • excessive length of screws
Anatomy

Presentation
  • Symptoms
    • groin pain 
  • Physical Exam
    • findings are subtle and may include
      • slight limp
      • tenderness in the groin. 
      • palpable snap may be detected (rare)
    • provocative tests
      • pain may be reproduced or exacerbated by resisted seated hip flexion or straight leg raise
Imaging
  • Radiographs
    • required views
      • AP pelvis
      • AP and lateral of hip
  • CT scan
    • helpful to determine postition of prosthesis and rule out other caused of symtpoms
  • MRI
    • usually not valuable due to artifact.
Studies
  • Diagnostic injection
    • diagnostic cortisone injection into iliopsoas sheath is helpful in diagnosis
Treatment
  • Nonoperative
    • indications
      • rare - most patients require operative intervention for complete resolution of symptoms
  • Operative
    • iliopsoas tenotomy or resection
      • indications
        •  in cases of normal post-op radiographs 
    • acetabular component revision
      • indications
        • in cases of excessive anterior cup overhang 
Technique
 

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Questions (2)

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(OBQ11.167) A 62-year-old female has persistent activity related anterior groin pain 10 months after total hip arthroplasty (THA). Infection workup is negative. New radiographs are unchanged compared to the intial films provided in Figures A and B. Pain is temporarily relieved following an injection of lidocaine and cortisone into the iliopsoas tendon sheath. What is the next appropriate treatment option? Review Topic

QID: 3590
FIGURES:
1

Indefinite activity modification

2%

(54/2958)

2

Iliopsoas tendon release

76%

(2238/2958)

3

Femoral component revision

6%

(186/2958)

4

Acetabular component revision

15%

(433/2958)

5

Femoral and acetabular component revision

1%

(29/2958)

L 2

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SUBMIT RESPONSE 2

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(OBQ10.191) A 65-year-old male complains of continued groin pain 18 months following total hip arthroplasty. The pain is worse with activity, specifically with hip extension during gait. Hip radiographs show no fracture or loosening of the components. Lab values including ESR and CRP are within normal limits, and a hip aspiration yields a nucleated cell count of 500 and no growth on culture. Which of the following is most likely to determine the nature of the continued pain? Review Topic

QID: 3283
1

Greater trochanteric bursa injection

2%

(42/2782)

2

Repeat aspiration of the hip joint

1%

(30/2782)

3

Local anesthetic injection of the iliopsoas tendon sheath

91%

(2537/2782)

4

Ober test on physical exam

4%

(110/2782)

5

Radiographs of the knee

2%

(57/2782)

L 1

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SUBMIT RESPONSE 3
ARTICLES (3)
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