Irritation of the iliopsoas tendon is one of the causes of pain after total hip arthroplasty. Many studies have been published on painful total hip arthroplasty caused by the iliopsoas tendon. In a recent study published in the American journal “Arthroscopy”, an attempt was made to review the literature systematically in patients who underwent open or arthroscopic release of the iliopsoas tendon after total hip arthroplasty.
The inclusion criteria were outcomes after open or arthroscopic release of the iliopsoas tendon, with a follow-up of at least six months, the English language and human studies. The exclusion criteria were case reports, studies concerning non-operative management or revision of the acetabular component, and articles with no specific diagnosis of iliopsoas tendinitis, or those in which open and arthroscopic treatment of the iliopsoas were reported as mixed series.
131 studies were examined, with only 7 meeting all the inclusion criteria (4 studies with arthroscopic tenotomy and 3 studies with open tenotomy). In total the review covered 88 patients, with 61 patients treated arthroscopically and 27 by open tenotomy. Overall, 77 of the 88 patients showed successful outcomes postoperatively. In the group treated arthroscopically, 91.8% (56 of the 61) of the patients had satisfactory results, while among those treated by open tenotomy 77.8% (21 of the 27) of the patients showed successful outcomes. Among the patients with signs of mechanical rubbing due to prominence of the acetabular component, those who underwent open tenotomy had complete relief of pain in 75% of cases, compared with those treated arthroscopically, in whom the figure was 93% (40 of the 43 patients).
Arthroscopic release for the management of iliopsoas tendinitis is recommended as an effective and minimally invasive technique which, moreover, has a low complication rate compared with open tenotomy. Tenotomy, whether open or arthroscopic, is a successful option for iliopsoas tendinitis, including in patients with signs of mechanical impingement, and is advised before revision of the acetabular component.
Source: A Systematic Review of Arthroscopic Versus Open Tenotomy of Iliopsoas Tendonitis After Total Hip Replacement. Review article. O''Connell RS, Constantinescu DS, Liechti DJ, Mitchell JJ, Vap AR. Arthroscopy. 2018 Jan 17. pii: S0749-8063(17)31436-6
