Surgical Technique: Arthroscopic Iliopsoas Lengthening After THA
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.
KeywordsAcetabular Component Prosthetic Component Anterolateral Portal Psoas Major Iliopsoas Tendon
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