Anterior iliopsoas impingement after total hip arthroplasty.
ABSTRACT Pain after total hip arthroplasty (THA) can be caused by a multitude of conditions, including infection, aseptic loosening, heterotopic ossification, and referred pain. It is also recognized that soft tissue inflammation about the hip, such as trochanteric bursitis, can lead to hip pain after THA. Two cases of persistent iliopsoas tendinitis following THA are reported, which are believed to be caused by psoas tendon impingement against a malpositioned, uncemented, metal-backed acetabular component. The authors are unaware of previous reports of this problem, and suggest that the problem be considered in the differential diagnosis of groin pain following THA.
Article: Treatment of iliopsoas tendinitis after a left total hip arthroplasty with botulinum toxin type A.[show abstract] [hide abstract]
ABSTRACT: Treatment of iliopsoas tendinitis after a left total hip arthroplasty with botulinum toxin type A (BTX-A). Case study. Outpatient musculoskeletal clinic. Single patient subject with left iliopsoas tendinitis after a left total hip arthroplasty. Fluoroscopically guided injection of 100 units of BTX-A into the left iliopsoas muscle. Functional improvement with Oswestry Disability Index (ODI) and scores using a 0-10 point pain intensity numerical rating scale (PI-NRS) at one and 6 months follow up. A 71-year-old female with 4 months of left groin pain after successful total hip arthroplasty. Work up did not reveal any infection or malpositioning of the left hip prosthetic components. Attempts at aspiration revealed no fluid in the joint space. A positive xylocaine muscle block confirmed a diagnosis of iliopsoas tendinitis. The BTX-A injection resulted in an improved left groin pain rating from a baseline of 7 to 1 and improved ability to flex her left hip at one month follow up. Pain was rated 8 at six months follow up. ODI improved from a baseline of 26% to 22% at one month follow up and 18% at 6 months follow up. Iliopsoas tendinitis is an uncommon cause of groin pain but has been described after a total hip arthroplasty in several case reports. Non-operative management has not been well established but includes anesthetic and corticosteroid injection into the muscle. The use of botulinum toxin A provided significant pain relief, functional improvement, and may represent an alternative to the surgical management of iliopsoas tendinitis.Pain physician 08/2007; 10(4):565-71. · 10.72 Impact Factor
Article: Rupture of the ilio-psoas tendon after a total hip arthroplasty: an unusual cause of radio-lucency of the lesser trochanter simulating a malignancy.[show abstract] [hide abstract]
ABSTRACT: Avulsion fracture or progressive radiolucency of lesser trochanter is considered a pathognomic finding in patients with malignancies. Although surgical release of the iliopsoas tendon may be required during a total hip arthroplasty (THA), there is no literature on spontaneous rupture of the ilio-psoas tendon after a THA causing significant functional impairment. We report here such a case, which developed progressive radiolucency of the lesser trochanter over six years after a THA, simulating a malignancy. The diagnosis was confirmed by MRI. Because of the chronic nature of the lesion, gross retraction of the tendon into the pelvis, and low demand of our patient, he was treated by physiotherapy and gait training. Injury to the ilio-psoas tendon can occur in various steps of the THA and extreme care should be taken to avoid this injury. Prevention during surgery is better, although there are no reports of repair in the THA setting. This condition should be considered in patients who present with progressive radioluceny of the lesser trochanter, especially in the setting of a hip/pelvic surgery. Awareness and earlier recognition of the signs and symptoms of this condition will aid in diagnosis and will direct appropriate management.Journal of Orthopaedic Surgery and Research 01/2010; 5:6.
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ABSTRACT: It is often challenging to find the causes for postoperative pain syndromes after total hip replacement, since they can be very allotropic. One possible cause is the muscular impingement syndrome. The most commonly known impingement syndrome is the psoas impingement. Another recently described impingement syndrome is the obturator externus muscle impingement. The aim of this study is to analyze pathological conditions of the Obturator externus and to show possible causes. 40 patients who had undergone a total hip replacement were subjected to clinical and MRI examinations 12 months after the surgery. The Harris Hip Score (HHS) was used to analyze pain and function. Additionally, a satisfaction score and a pain score (VAS) were determined. The MRI allowed for the assessment of the spatial relation between the obturator externus muscle and the acetabulum. Also measured were the acetabular inclination angle as well as the volume and cross-sectional area of the obturator externus muscle. The patients were assigned to 3 groups in accordance with their MRI results. Group 1 patients (n = 18) showed no contact between the obturator externus and the acetabulum. Group 2 (n = 13) showed contact, and group 3 (n = 9) an additional clear displacement of the muscle in its course. It was not possible to establish a connection between the imaging findings, the HHS, the VAS, and patient satisfaction. What was striking, however, was a significant difference between the median inclination angle in group 1 (40 degrees +/- 5.4 degrees ) and group 3 (49 degrees +/- 4.7 degrees ) (p < 0.05), and the corresponding image-morphological pathology. The average inclination angle in group 2 was 43.3 degrees +/- 3.8 degrees Contact between the obturator externus muscle and the caudal acetabula border occurs frequently, but is only rarely accompanied by a painful muscular impingement. The position of the acetabula must be seen as one of the main risk factors for contact between the acetabula border and the obturator. The hip replacement process must provide for sufficient osseous coverage of the caudal acetabula border. Furthermore, the retention of the transverse ligament may serve as protective cover for the incisura acetabuli.Journal of Orthopaedic Surgery and Research 01/2010; 5:44.