Iliopsoas pathology is a relatively uncommon cause of pain after total hip arthroplasty, typically presenting with groin pain on active flexion or extension of the hip. Various surgical and conservative approaches to treatment have been reported.
A new review study reported the incidence of iliopsoas pathology and also the results of its treatment.
In a database of 1000 patients who had undergone total hip arthroplasty, the postoperative incidence of iliopsoas pathology was measured retrospectively. Conservative and surgical methods of treating it were also assessed.
In all, 24 patients with symptomatic iliopsoas pathology were identified, giving an incidence of the order of 2.4%. While the mean age of the patients who underwent total hip arthroplasty was 65 years, the mean age at which iliopsoas pathology developed was 54 years (28 to 67). Younger patients, and those who underwent total hip arthroplasty for conditions other than primary osteoarthritis, were at greater risk of developing this complication. Ultrasound-guided steroid injections and physiotherapy resulted in complete relief of symptoms in 61% of cases, partial relief in 13% and no effect in 26%. Eight of the 24 patients eventually underwent surgical treatment, including tenotomy (n=7), and in one the acetabular implant was repositioned.
The authors concluded that in this, the largest series of patients assessing iliopsoas pathology after total hip arthroplasty, there was a higher incidence of the condition in young patients, probably because of the different surgical indications. Total arthroplasty for Perthes disease and hip dysplasia in particular involves an increase in the length of the limb, as well as in the horizontal distance from the centre of rotation. This in turn may increase the tension in the iliopsoas tendon and give rise to a higher risk of irritation. Ultrasound-guided injection of steroid is a low-risk and relatively effective technique. In resistant cases, possible release or division of the tendon should be considered. Finally, patients should be informed of the risk of persistent groin pain when they are due to undergo total hip arthroplasty.
Source: “Bone and Joint Journal”, February 2021