Database arthroscopic psoas release for Anterior Iliopsoas Impingement after THA
Description
The purpose of the study was to evaluate the efficacy of arthroscopic treatment of iliopsoas impingement after THA, in cases of malposition of the acetabular component or threaded cups. The main hypothesis was that this technique provides groin pain resolution and improves clinical outcomes. We also sought to identify radiographic features in order to identify predictors of failure. We retrospectively reviewed all cases of patients with a diagnosis of iliopsoas impingement after primary THA treated with arthroscopic release at two tertiary level hospitals between June 2009 and September 2016. Institutional Ethics Committee approval was obtained. All patients were treated conservatively for at least 6 months with anti-inflammatory medication, physical therapy and had an injection of local anesthetic and corticosteroids into the iliopsoas tendon sheath in order to confirm the diagnosis. A minimum follow-up of 2 years was required and common causes of pain after hip arthroplasty, such as infection or loosening, were ruled out in all cases. A radiological analysis was performed in all cases. Inclination of the acetabular component was measured on the anteroposterior pelvic radiograph, and version and anterior acetabular component prominence were measured on true lateral hip radiographs (Figure 3). Measurement of this overhang was adjusted, correcting for the magnification with digital radiographs in order to ascertain real distances. Cup malposition was defined as less than 10º of anteversion, or more than 50º degrees or less than 40º of inclination. The primary clinical outcomes evaluated were the groin pain with a visual analogue scale (VAS) and the Harris Hip Score (HHS)27 at the most recent follow-up. A VAS value of 0 to 2 was considered to indicate that groin pain had resolved. Secondary outcomes included the strength of the hip flexion, measured with the Medical Research Council (MRC) scale28, reinterventions and complications.