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  • Title: Outside-in arthroscopic psoas release for anterior iliopsoas impingement after primary total hip arthroplasty.
    Author: Moreta J, Cuéllar A, Aguirre U, Casado-Verdugo ÓL, Sánchez A, Cuéllar R.
    Journal: Hip Int; 2021 Sep; 31(5):649-655. PubMed ID: 32093495.
    Abstract:
    PURPOSE: 1 of the causes of groin pain after total hip arthroplasty (THA) is impingement of the iliopsoas tendon. The purpose of this study was to present our results with outside-in arthroscopic tenotomy for iliopsoas impingement after THA. METHODS: We retrospectively reviewed 12 patients treated between 2009 and 2016 with a minimum follow-up of 2 years. Anterior acetabular component prominence was measured on a true lateral hip radiograph. A transcapsular tenotomy was performed near the edge of the acetabular component through an outside-in arthroscopic approach. The primary clinical outcomes evaluated were groin pain, assessed with a visual analogue scale (VAS), and the Harris Hip Score (HHS). Secondary outcomes included strength of hip flexion, measured with the Medical Research Council (MRC) scale. RESULTS: All patients had groin pain improvement, though one patient continued to have moderate pain. The mean VAS score was significantly lower postoperatively (1.08) than preoperatively (6.2) (p < 0.001). The mean HHS improved from 58.8 (range, 37-76) to 86.1 (range, 59-98) (p = 0.001). The average postoperative MRC Scale was 4.58. The mean anterior prominence was 7.25 mm (range 3-12 mm). In patients with <10 mm of component prominence, tenotomy provided groin pain resolution in all cases (n = 8). In patients with ⩾10 mm of prominence, symptoms resolved in 3 out of 4 cases. CONCLUSIONS: Outside-in arthroscopic iliopsoas release provided a high rate of success with no complications in this study, even in patients with moderate acetabular component prominence.
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