Please confirm topic selection

Are you sure you want to trigger topic in your Anconeus AI algorithm?

Please confirm action

You are done for today with this topic.

Would you like to start learning session with this topic items scheduled for future?

Updated: Aug 16 2024

THA Iliopsoas Impingement

Images
https://upload.orthobullets.com/topic/12747/images/5dcd85b1-2d74-4712-ab9e-829f6921c9ad_tha_impingment..jpg
  • Summary
    • THA Iliopsoas Impingement is an under recognized cause of recurrent groin pain after total hip replacement which may be caused by a malpositioned acetabular component.
    • Diagnosis may be suspected clinically with pain with resisted seated hip flexion or straight leg raise and the presence of anterior cup overhang on CT. Diagnostic cortisone injection into iliopsoas sheath is helpful in diagnosis.
    • Treatment is generally arthroscopic iliopsoas tenotomy in the setting of normal cup position. Revision of the acetabulum component may be indicated in cases of excessive anterior overhang.
  • Etiology
    • May be caused by
      • retained cement
      • malpositioned acetabular component
      • limb length discrepancy
      • excessive length of screws
  • Anatomy
    • Illiopsoas 
  • Presentation
    • Symptoms
      • groin pain
      • average time from index procedure to symptom onset is 20 months
    • Physical Exam
      • findings are subtle and may include
        • slight limp
        • tenderness in the groin.
        • palpable snap may be detected (rare)
      • provocative tests
        • pain may be reproduced or exacerbated by resisted seated hip flexion or straight leg raise
  • Imaging
    • Radiographs
      • required views
        • AP pelvis
        • AP and lateral of hip
    • CT scan
      • helpful to determine postition of prosthesis and rule out other caused of symtpoms
    • MRI
      • usually not valuable due to artifact.
  • Studies
    • Diagnostic injection
      • diagnostic cortisone injection into iliopsoas sheath is helpful in diagnosis
  • Treatment
    • Nonoperative
      • observation
        • indications
          • rare
            • most patients require operative intervention for complete resolution of symptoms
    • Operative
      • arthroscopic iliopsoas tenotomy
        • indications
          • in cases of normal post-op radiographs
      • acetabular component revision
        • indications
          • in cases of excessive anterior cup overhang
  • Technique
Card
1 of 4
Question
1 of 10
Private Note