Archives of Orthopaedic and Trauma Surgery

, Volume 139, Issue 2, pp 211–216 | Cite as

An operative technique for psoas impingement following total hip arthroplasty: a case series of day case, extra articular, arthroscopic psoas tenotomy

  • M. WilliamsEmail author
  • M. Ashworth
Arthroscopy and Sports Medicine



We present a prospective case series of patients undergoing an arthroscopic, extra-articular psoas tenotomy.


From February 2009 to February 2017, 13 consecutive patients underwent day case, arthroscopic tenotomy. Patients were selected following clinical evidence of impingement and a diagnostic ultra-sound-guided steroid injection of the psoas bursa. The patient’s mean age was 52.8 years ± 13.7 (29.1–82.7), mean ASA 1.8 and mean BMI 30.6 ± 8.5 kg/m2. We detail the technique employed and patient outcomes to include FABER testing, manual hip flexion strength assessment and pain improvements.


The typical onset of impingement symptoms following THA was 4 months (2–24 months). 9 patients tested FABER negative and 62% (n = 8) were pain-free within 6–12 weeks. An average 20% (5–30%) reduction in hip flexion strength was seen post-arthroscopy. The mean follow-up was 2 years, (0.5–7 years). Regarding complications, one patient required revision surgery due to recurrence prompting a technique adaptation.


For psoas impingement following THA where non-operative measures are ineffective, we recommend extra-articular arthroscopic psoas tenotomy as a feasible operative strategy. This minimally invasive, day case, low-risk treatment option is beneficial in relieving impingement symptoms.


Hip arthroscopy Psoas tenotomy Extracapsular tenotomy Total hip replacement 



There is no funding source.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article was a retrospective review of prospective collected data on our routine clinical practice, no ethical approval was required.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Trauma and Orthopaedic SurgeryTorbay HospitalTorquayUK

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