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
QUESTIONS 1 of 2 1 2 Previous Next (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% (41/2647) 2 Repeat aspiration of the hip joint 1% (30/2647) 3 Local anesthetic injection of the iliopsoas tendon sheath 91% (2413/2647) 4 Ober test on physical exam 4% (105/2647) 5 Radiographs of the knee 2% (54/2647) ML 1 Select Answer to see Preferred Response PREFERRED RESPONSE 3 (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: A B 1 Indefinite activity modification 2% (48/2793) 2 Iliopsoas tendon release 76% (2116/2793) 3 Femoral component revision 6% (180/2793) 4 Acetabular component revision 15% (407/2793) 5 Femoral and acetabular component revision 1% (26/2793) ML 2 Select Answer to see Preferred Response PREFERRED RESPONSE 2