The iliopsoas is a powerful flexor of the hip joint. As one of the largest muscles in the human body it often develops pathology in the form of tendinitis or tendinopathy. In addition, iliopsoas dysfunction can also produce symptoms in patients who have undergone hip arthroscopy for femoroacetabular impingement and a tear of the labrum of the acetabulum.
A recent study showed that problems with the iliopsoas can also arise after hip arthroscopy and can be a possible cause of symptoms in such patients. Although iliopsoas pathology is well known to orthopaedic surgeons who perform hip arthroscopy, many details are still not clear.
This study looked at patients who underwent hip arthroscopy for femoroacetabular impingement between March 2015 and July 2017. Cases with hip dysplasia were not included in this cohort. All the patients had a combination of cam or pincer femoroacetabular impingement together with a lesion of the labrum of the acetabulum. There were no patients with a diagnosis of tendinitis around the hip. All the patients were assessed with the Harris Hip Score and Nonarthritic Hip Score hip outcome scores, which were recorded preoperatively and one year postoperatively.
A total of 258 hip arthroscopies were studied and 18 cases of iliopsoas tendinitis were diagnosed on ultrasound. Iliopsoas tendinitis was diagnosed at a mean of 2.8 ± 1.8 months after surgery. There were no significant differences in the patients' demographic data. The 18 patients were treated with a steroid (cortisone) injection under ultrasound guidance. In all the patients the iliopsoas tendinitis was confirmed by the positive response to the steroid injection, and most of them had immediate relief of symptoms, while a few improved after several more months. No patient needed to undergo revision surgery for this problem.
The authors concluded that iliopsoas tendinitis is a common source of pain after hip arthroscopy and can be effectively diagnosed and treated with an injection under ultrasound guidance. Surgeons who perform hip arthroscopy should therefore be aware of this possibility and should manage accordingly those patients who present with hip pain on flexion of the joint.
Source: “Hip International”, February 2020