Surgical release of iliopsoas tendon for groin pain after total hip arthroplasty

Bone cement pressurisation is considered to be an advance in bone microlock fixation of the acetabular and femoral components of total hip arthroplasty. We have identified a previously unreported complication of this technique in which the pressurised cement extruded through an anterior pubic anchor drill hole giving early and persistent anterior groin pain. This paper reports on the condition, its incidence and treatment in four cases.

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Comparative Outcomes Assessment: Hip Hemiarthroplasty as an Alternative to THA in Patients with Surgically Pristine Acetabulum—Is There Still a Role?

ISRN Orthopedics ◽

10.1155/2013/632126 ◽

2013 ◽

Vol 2013 ◽

pp. 1-6

Author(s):

Thomas B. Pace ◽

Brad Prather ◽

Brian Burnikel ◽

Brayton Shirley ◽

Stephanie Tanner ◽

...

Keyword(s):

Overall Survival ◽

Survival Rate ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Groin Pain ◽

Long Term Results ◽

Overall Survival Rate ◽

Total Hip ◽

Group 2 ◽

Group 1

This is a retrospective review of 243 hip arthroplasties treated with either hemiarthroplasty (61 surgeries-Group 1) or total hip arthroplasty (182 surgeries-Group 2). The mid- to long-term results of relatively similar, predominately young patient cohorts were assessed annually via radiographs and the Harris Hip Scores for pain and clinical function. Groin pain persisted in 16.4% of Group 1 and 5.5% of Group 2 (). Thigh pain persisted in 11.5% of Group 1 and 2.2% of Group 2 (). Complications in Group 1 were 4/61 including 2 revisions with an overall survival rate of 96.7% versus Group 2 complication rate of 29/182 with 15 revisions and an overall survival rate of 91.8%. There were no cases of acetabular protrusio in Group 1, but 2 cases (1%) in Group 2 had cup loosening or osteolysis. Two cases were revised in Group 1 (3.2%). Both were undersized femoral stems. The fifteen revisions (8.2%) in Group 2 included loose stem (1), instability (8), infections (3), cup loosening (2), and accelerated polyethylene wear (1). Hemiarthroplasty has a higher incidence of thigh and groin pain but fewer complications compared with total hip arthroplasty.

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The Prevalence of Groin Pain After Metal-on-Metal Total Hip Arthroplasty and Total Hip Resurfacing

Clinical Orthopaedics and Related Research ◽

10.1007/s11999-010-1356-y ◽

2010 ◽

Vol 468 (9) ◽

pp. 2346-2356 ◽

Cited By ~ 77

Author(s):

Robert B. Bartelt ◽

Brandon J. Yuan ◽

Robert T. Trousdale ◽

Rafael J. Sierra

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Groin Pain ◽

Hip Resurfacing ◽

Total Hip ◽

Metal On Metal

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Conversion of Failed Hip Resurfacings to Total Hip Arthroplasty- A Favorable Solution with Satisfactory Outcomes

10.21203/rs.3.rs-923911/v1 ◽

2021 ◽

Author(s):

Abdel-hamid A Atalla ◽

Abdel-hamid ◽

Bahaa A Kornah ◽

Mohamed Abdel-AAl ◽

Abdel-Aleem Soltan

Keyword(s):

Total Hip Arthroplasty ◽

Femoral Neck ◽

Surgical Site Infection ◽

Heterotopic Ossification ◽

Hip Arthroplasty ◽

Groin Pain ◽

Hip Resurfacing ◽

Site Infection ◽

Total Hip

Abstract Background: Hip resurfacing had been utilized since the 1950s. The concept favored for young active patients owing to its proposed advantages. Revision rate of hip resurfacing in most national registries nearly 3.5%. Conversion to total hip replacement may be the correct option for old patients and those whose activity levels changed and the need for hip resurfacing no longer required.Purpose: The aim of this study is to assess the mid-term outcomes of converting failed hip resurfacing arthroplsty to total hip arthroplasty. Primary outcomes included improvement of Oxford, WOMAC, Harris and UCLA hip scores. Also; radiological follow-up has been evaluated for component stability or signs of loosening. Secondary outcomes included surgical site infection, residual groin pain, and heterotopic ossification. Most of patients (22 patients (88%) reported relief of pain and good to excellent patient satisfaction. Study design: Prospective case series study.Level of evidence: Therapeutic IV.Patients and Methods:Twenty–five patients (fifteen males) with failed hip resurfacing arthroplasty converted to total hip arthroplasty enrolled in this study. Mean age 56.8 years. Mean time to revision 36.8 months. Indications for revision included: femoral neck fractures (10 cases), femoral neck thinning (3 cases), component loosening (4 cases) component dislocation (2 cases) persistent groin pain and clicking (3 cases) and wear of components (3 cases). Nineteen patients revised both components while remaining six underwent revision of femoral component only. Results:The average duration of follow up was 26.8 months (28-48 months). The study was an intermediate term follow-up. Clinical outcome evaluated through Oxford, WOMAC, Harris and UCLA hip scores. Preoperative scores 21.3, 78.3, 35,7 and 2 respectively improved to 39.8, 11.1, 92.3 and 7 respectively at last follow-up representing statistically significant improvements over pre-operative scores (p < 0.0001 for each score) Radiological follow-up evaluated for component stability or signs of loosening. No cases of neurological, vascular, deep infection or implant failure. There were 3 cases (3%) with complications. one case complicated by surgical site infection with serous drainage for more than seven days and treated with oral antibiotics and daily dressings. One case had residual groin pain, and third case had mild heterotopic ossification. All patients were satisfied particularly by their pain relief. Average post operative Oxford, Harris and WOMAC hip scores were 17.4, 89.8 and 6.1 respec-tively. representing statistically significant improvements over pre operative scores (p < 0.0001 for each score)Conclusions: study shows conversion of hip resurfacing to THA has high satisfaction rates. These results compare favorably with those for revision total hip arthroplasty

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Hip and Groin Injuries in Professional Basketball Players: Impact on Playing Career and Quality of Life After Retirement

Sports Health A Multidisciplinary Approach ◽

10.1177/1941738119838274 ◽

2019 ◽

Vol 11 (3) ◽

pp. 218-222 ◽

Cited By ~ 6

Author(s):

Seper Ekhtiari ◽

Moin Khan ◽

Tyrrell Burrus ◽

Kim Madden ◽

Joel Gagnier ◽

...

Keyword(s):

Quality Of Life ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Groin Pain ◽

Activity Level ◽

Basketball Players ◽

Professional Basketball ◽

Total Hip ◽

Increased Risk

Background: Professional basketball players are at increased risk of hip and groin pain. Epidemiologic data exist on the prevalence of hip and groin issues among players in the National Basketball Association (NBA), but little is known about how these injuries affect athletes after retirement. Hypothesis: A high proportion of retired NBA athletes would have hip and/or groin pain. Study Design: Cross-sectional survey. Level of Evidence: Level 4. Methods: A survey was developed through an interdisciplinary focus group. The survey was developed to capture data regarding demographics, collegiate and professional athletic injuries, and current quality of life and musculoskeletal health. The questionnaire was electronically distributed to all members of the National Basketball Players Association using SurveyMonkey (N = 900). Results: A total of 108 (12%) retired NBA players completed the survey. More than one-third (36.3%) of athletes report currently experiencing hip and/or groin pain, and 17.6% had received injections for hip or groin conditions since retiring from the NBA. Since retiring, 14.7% of respondents had undergone total hip arthroplasty. The median Tegner activity level scale was 3 out of 10. Nearly one-third (32.4%) of athletes report moderate to severe problems with mobility, and close to half (48%) had moderate to extreme pain/discomfort. Conclusion: Hip and groin injuries are common among NBA athletes, affecting players throughout their careers and into retirement. A subset of athletes may exist in whom intra-articular hip pathology is not appropriately identified and treated while playing in the NBA. Clinical Relevance: Retired NBA athletes are at high risk of hip and groin pain after retirement and are more likely to require total hip arthroplasty compared with the general population.

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Iliopsoas pathology after total hip arthroplasty: a young person’s complication

The Bone & Joint Journal ◽

10.1302/0301-620x.103b2.bjj-2020-1318.r1 ◽

2021 ◽

Vol 103-B (2) ◽

pp. 305-308

Author(s):

Matthew Howell ◽

Fraser J. Rae ◽

Aman Khan ◽

Graeme Holt

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Groin Pain ◽

Steroid Injection ◽

Case Series ◽

Leg Length ◽

Younger Patients ◽

Total Hip ◽

Active Flexion ◽

The Mean

Aims Iliopsoas pathology is a relatively uncommon cause of pain following total hip arthroplasty (THA), typically presenting with symptoms of groin pain on active flexion and/or extension of the hip. A variety of conservative and surgical treatment options have been reported. In this retrospective cohort study, we report the incidence of iliopsoas pathology and treatment outcomes. Methods A retrospective review of 1,000 patients who underwent THA over a five-year period was conducted, to determine the incidence of patients diagnosed with iliopsoas pathology. Outcome following non-surgical and surgical management was assessed. Results In all, 24 patients were diagnosed as having developed symptomatic iliopsoas pathology giving an incidence of 2.4%. While the mean age for receiving a THA was 65 years, the mean age for developing iliopsoas pathology was 54 years (28 to 67). Younger patients and those receiving THA for conditions other than primary osteoarthritis were at a higher risk of developing this complication. Ultrasound-guided steroid injection/physiotherapy resulted in complete resolution of symptoms in 61% of cases, partial resolution in 13%, and no benefit in 26%. Eight out of 24 patients (who initially responded to injection) subsequently underwent surgical intervention including tenotomy (n = 7) and revision of the acetabular component (n = 1). Conclusion This is the largest case series to estimate the incidence of iliopsoas pathology to date. There is a higher incidence of this condition in younger patients, possibly due to the differing surgical indications. Arthoplasty for Perthes' disease or developmental dysplasia of the hip (DDH) often results in leg length and horizontal offset being increased. This, in turn, may increase tension on the iliopsoas tendon, possibly resulting in a higher risk of psoas irritation. Image-guided steroid injection is a low-risk, relatively effective treatment. In refractory cases, tendon release may be considered. Patients should be counselled of the risk of persisting groin pain when undergoing THA. Cite this article: Bone Joint J 2021;103-B(2):305–308.

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Prevalence of groin pain after primary dual-mobility total hip arthroplasty

Hip International ◽

10.1177/11207000211039168 ◽

2021 ◽

pp. 112070002110391

Author(s):

Karina A Lenartowicz ◽

Cody C Wyles ◽

Samuel W Carlson ◽

Rafael J Sierra ◽

Robert T Trousdale

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Groin Pain ◽

Hip Resurfacing ◽

Dual Mobility ◽

Total Hip ◽

Large Head ◽

Increased Risk ◽

Patient Questionnaires ◽

Historical Controls

Background: Instability remains a challenging problem following total hip arthroplasty (THA). Dual-mobility (DM) components are used with increasing frequency to mitigate this potential complication. As has been shown with larger metal-on-metal (MoM) THA, the larger size femoral head may pose an increased risk of groin pain. This study aims to evaluate the prevalence of groin pain following primary DM THA compared to other THA constructs. Methods: We identified 190 primary THAs (183 patients) performed with DM components at a single academic institution from 2008 to 2017. We retrospectively reviewed standardised patient questionnaires and the electronic medical record to determine the prevalence of groin pain. DM patients were compared to historical controls of 39 MoM hip resurfacing, 26 large-head MoM THA, and 217 conventional THA. Mean age was 64 years, 58% were female, mean body mass index was 30 kg/m2, and mean follow-up was 3.5 years (range 2–8 years). Results: The prevalence of groin pain in patients with DM components was 5%, similar to the prevalence reported by patients with conventional THA (7%). There was a decreased prevalence of groin pain in DM patients compared to hip resurfacing (18%) and MoM THA (15%). Among the 9 DM patients with groin pain, 1 was treated with iliopsoas injection, and 1 underwent radiofrequency ablation of the articular nerve. Conclusions: This study documents a relatively low prevalence of groin pain among primary DM THA patients. This is comparable with historical controls of conventional THA and decreased compared to hip resurfacing and large head MoM THA.

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