Advertisement

Surgical Technique: Arthroscopic Iliopsoas Lengthening After THA

Reference work entry

Abstract

A small proportion of total hip arthroplasty (THA) patients remain symptomatic with persistent groin discomfort may have an underlying iliopsoas impingement. Other causes of residual hip pain such as loosening, infection, aseptic lymphocyte-dominated vasculitis-associated lesion (ALVAL), and gross component malposition are first excluded. In patients with positive diagnostic block of iliopsoas and failure of nonoperative rehabilitation, an arthroscopic iliopsoas release and lengthening can be safely undertaken. Iliopsoas muscle-tendon complex is formed of psoas major, psoas minor (60 % of individuals), and iliacus. Relative retroversion, decreased abduction angle, and oversizing of prosthetic acetabular component may predispose the patient to iliopsoas pathology. The iliopsoas impingement may occur at the acetabular component margin or over the large prosthetic femoral head. A two-portal arthroscopic approach is employed, and iliopsoas lengthening is undertaken using radiofrequency probe either at the acetabular component margin or anterior to the prosthetic femoral head-neck junction in the peripheral compartment depending on the site of impingement. Distal release at the lesser trochanter is also feasible. Only tendinous portion of the iliopsoas muscle-tendon complex is released. A structured rehabilitation plan ensures functional recovery within 12 weeks for the majority of the patients.

Keywords

Acetabular Component Prosthetic Component Anterolateral Portal Psoas Major Iliopsoas Tendon 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Santić V, Legović D, Sestan B, Jurdana H, Marinović M. Measuring improvement following total hip and knee arthroplasty using the SF-36 Health Survey. Coll Antropol. 2012;36(1):207–12.PubMedGoogle Scholar
  2. 2.
    Piscitelli P, Iolascon G, Innocenti M, Civinini R, Rubinacci A, Muratore M, D'Arienzo M, Leali PT, Carossino AM, Brandi ML. Painful prosthesis: approaching the patient with persistent pain following total hip and knee arthroplasty. Clin Cases Miner Bone Metab. 2013;10(2):97–110.PubMedCentralPubMedGoogle Scholar
  3. 3.
    Henderson RA, Lachiewicz PF. Groin pain after replacement of the hip: aetiology, evaluation and treatment. J Bone Joint Surg Br. 2012;94(2):145–51.PubMedCrossRefGoogle Scholar
  4. 4.
    Wuenschel M, Kunze B. Iliopsoas cyst causing persistent pain after total hip arthroplasty. Orthopedics. 2011;34(5):396.PubMedGoogle Scholar
  5. 5.
    Braun KF, Siebenlist S, Sandmann G, Martetschläger F, Kraus T, Ehnert S, Neumaier M, Freude T, Stöckle U. Recurrent hematomas of the iliopsoas muscle after total hip replacement as a differential diagnosis for chronic groin pain: case series report. Orthopade. 2012;41(3):212–6.PubMedCrossRefGoogle Scholar
  6. 6.
    Van Riet A, De Schepper J, Delport HP. Arthroscopic psoas release for iliopsoas impingement after total hip replacement. Acta Orthop Belg. 2011;77(1):41–6.PubMedGoogle Scholar
  7. 7.
    Van Dyke JA, Holley HC, Anderson SD. Review of iliopsoas anatomy and pathology. Radiographics. 1987;7(1):54–84.Google Scholar
  8. 8.
    Chang CY, Huang AJ. MR imaging of normal hip anatomy. Magn Reson Imaging Clin N Am. 2013;21(1):1–19.PubMedCrossRefGoogle Scholar
  9. 9.
    Blomberg JR, Zellner BS, Keene JS. Cross-sectional analysis of iliopsoas muscle-tendon units at the sites of arthroscopic tenotomies: an anatomic study. Am J Sports Med. 2011;39(Suppl):58S–63.PubMedCrossRefGoogle Scholar
  10. 10.
    Cobb JP, Davda K, Ahmad A, Harris SJ, Masjedi M, Hart AJ. Why large-head metal-on-metal hip replacements are painful: the anatomical basis of psoas impingement on the femoral head-neck junction. J Bone Joint Surg Br. 2011;93(7):881–5.PubMedCrossRefGoogle Scholar
  11. 11.
    Bajwa AS, Villar RN. Arthroscopy of the hip in patients following joint replacement. J Bone Joint Surg Br. 2011;93(7):890–6.PubMedCrossRefGoogle Scholar
  12. 12.
    Kajino Y, Kabata T, Maeda T, Iwai S, Kuroda K, Fujita K, Tsuchiya H. Strict component positioning is necessary in hip resurfacing. J Orthop Sci. 2013;18(2):290–7.PubMedCrossRefGoogle Scholar
  13. 13.
    Andersson E, Oddsson L, Grundstrom H, Thorstensson A. The role of the psoas and iliacus muscles for stability and movement of the lumbar spine, pelvis and hip. Scand J Med Sci Sport. 1995;5(1):10–6.CrossRefGoogle Scholar
  14. 14.
    Bogduk N, Pearcy M, Hadfield G. Anatomy and biomechanics of psoas major. Clin Biomech. 1992;7:109–19.CrossRefGoogle Scholar
  15. 15.
    Jerosch J, Neuhäuser C, Sokkar SM. Arthroscopic treatment of iliopsoas impingement (IPI) after total hip replacement. Arch Orthop Trauma Surg. 2013;133(10):1447–54.PubMedCrossRefGoogle Scholar
  16. 16.
    Byrd JW. Evaluation and management of the snapping iliopsoas tendon. Instr Course Lect. 2006;55:347–55.PubMedGoogle Scholar
  17. 17.
    Seldinger SI. Catheter replacement of the needle in percutaneous arteriography; a new technique. Acta Radiol. 1953;39(5):368–76.PubMedCrossRefGoogle Scholar
  18. 18.
    Robertson WJ, Kelly BT. The safe zone for hip arthroscopy: a cadaveric assessment of central, peripheral, and lateral compartment portal placement. Arthroscopy. 2008;24(9):1019–26.PubMedCrossRefGoogle Scholar
  19. 19.
    Jayasekera N, Aprato A, Villar RN. Are crutches required after hip arthroscopy? A case-control study. Hip Int. 2013;23(3):269–73.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  1. 1.The Villar Bajwa PracticeImpingtonUK
  2. 2.The Richard Villar PracticeSpire Cambridge Lea HospitalImpingtonUK

Personalised recommendations