Arthroscopic tendon release for iliopsoas impingement after primary total hip arthroplasty: a retrospective, consecutive series

Introduction: Aim of this study was to describe the clinical outcomes of 16 patients with iliopsoas (IP) impingement after primary total hip arthroplasty (THA), treated with an arthroscopic tendon release. Methods: 16 patients (11 females/5 males), with a mean age of 57.8 +/- 11.1 years (age at THA: 54.4 +/- 11 years) and a diagnosis of IP impingement after primary THA, were treated with the Wettstein tenotomy. Preoperatively, every patient underwent a diagnostic ultrasonography guided peritendinous injection and a computed tomography (CT) scan. Every patient was clinically evaluated using WOMAC score. Subjective pain relief and active hip flexion strength were measured. Results: No complications related to arthroscopy were detected. Every cup was prominent with a mean axial overhang of 13 +/- 4.8 mm (range 5-20 mm). At a mean follow-up of 27 +/- 20.1 months (range 6-48 months), the WOMAC score was 83.7 +/- 10.1 points. 13 patients out of 16 (81.3%) had a complete pain relief. 14 patients out of 16 (88%) regained full active hip flexion strength at the final follow-up. 1 patient was scheduled for cup revision after 6 months, due to persistent symptomatology. No demographic data or CT measurements about cup position statistically influenced the outcome. Conclusions: When preceded by an appropriate diagnosis, arthroscopic tenotomy proved safe and effective for IP impingement, regardless the magnitude of cup protrusion.

Automated summary

This study found that arthroscopic tenotomy was safe and effective for iliopsoas impingement after primary THA, with high rates of pain relief and restoration of full hip flexion strength in most patients after surgery.