Abstract
Introduction
Iliopsoas impingement is a well described cause of groin pain after direct anterior total hip arthroplasty (THA). We proposed to evaluate the incidence, natural history and response to treatment of iliopsoas impingement after direct anterior total hip arthroplasty.
Methods
A retrospective chart review of 725 consecutive patients who underwent anterior approach total hip arthroplasty between 2009 and 2014 was conducted. All surgeries were performed by one of two surgeons. Patients were included if they underwent primary anterior approach THA and had a minimum of 2 years of follow up. Patients who had a posterior approach, revision surgery or had less than 2 years of follow up were excluded. Iliopsoas impingement was identified if patients reported groin pain at greater than 6 weeks of postoperative follow up and in association with pain with resisted seated hip flexion. The natural history and response to treatment was recorded for patients identified as having iliopsoas impingement.
Results
900 patients met inclusion criteria. Of these, 120 (13.4%) developed groin pain following direct anterior total hip arthroplasty. The average time of onset was at 21 months postoperatively. At 2 years postoperatively, 16% of patients had symptoms, whereas 84% had resolution. 28% of patients responded to structured physical therapy, 22% improved with home stretching, 19% improved after arthroscopic psoas release, 9% after psoas sheath injection, and 6% required acetabular component revision.
Conclusion
In our study population, iliopsoas impingement is not an uncommon finding after direct anterior total hip arthroplasty, but nearly half of these patients responded well to home stretching or physical therapy. In some cases, psoas injection and arthroscopic release was necessary. Rarely, cup revision was required for symptomatic relief.
