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Greater trochanteric bursa injection
2%
66/3557
Repeat aspiration of the hip joint
1%
46/3557
Local anesthetic injection of the iliopsoas tendon sheath
90%
3203/3557
Ober test on physical exam
4%
153/3557
Radiographs of the knee
76/3557
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The clinical presentation is consistent with anterior iliopsoas tendon impingement following total hip arthroplasty. Underlying infection has been ruled out by the appropriate labs and hip aspiration. Groin pain, pain with passive hip extension, and snapping pain in the groin raise the suspicion of iliopsoas tendinopathy. Cross-table lateral imaging and CT scan can be used to evaluate for protrusion of the anterior rim of the acetabular cup causing impingement with the tendon. The diagnosis is confirmed by relief of pain with anesthetic injection of the tendon sheath. Lachiewicz et al reviews the evaluation, diagnosis, and management of iliopsoas impingement and tendinopathy following total hip arthroplasty. Cross-table lateral imaging of the acetabular components position in relation to the anterior rim of the native acetabulum and iliopsoas tendon injections are critical portions of the diagnostic process. Duffy et al review the evaluation process of patients with continued pain following total hip arthroplasty in an instructional course lecture. A thorough history and physical exam are crucial to successfully determining the origin of pain. Illustration A is a cross-table lateral radiograph from this article demonstrating prominence of the anterior acetabular rim causing iliopsoas tendinopathy.
4.2
(30)
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