American Hip Institute

2013 – Endoscopic Iliopsoas Tenotomy for Iliopsoas Impingment Collared Femoral Prosthesis. – American Hip Institute

Abstract: Groin pain after total hip replacement is an uncommon event and may be the result of several causes, including iliopsoas impingement. We describe the case of a 51-year-old woman who was diagnosed with iliopsoas impingement after total hip replacement with a collared femoral stem. She did not improve despite extensive conservative treatment. She was treated by endoscopic iliopsoas tenotomy, and the surgical technique is described herein. Her preoperative groin pain and popping disappeared completely at 3 months postoperatively

First reported by Postel in 1975, 1 iliopsoas impingement or tendinitis is an under-recognized cause of hip and groin pain after total hip replacement (THR). Since this first report, several causes have been proposed, including prominent or malpositioned acetabular components, 2,3 retained cement, 3-5 excessively long screws, 3,6 and the presence of an acetabular cage or reinforcement ring. Additional factors that may contribute to the development of tendinitis are increased offset and leg-length discrepancy. Brew et al. 7 reported on a case of iliopsoas impingement caused by overhang of the collar. This was the first report of a collared stem causing impingement.
The patient was treated with revision of the stem to a collarless stem with resolution of the symptoms. We report on a patient who had a similar pathology, iliopsoas impingement caused by overhang of a collared femoral stem, treated by endoscopic iliopsoas tenotomy, with a favorable outcome (Tables 1 and 2).

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