Chalmers Brian P, Sculco Peter K, Sierra Rafael J, Trousdale Robert T, Berry Daniel J
1Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota.
J Bone Joint Surg Am. 2017 Apr 5;99(7):557-564. doi: 10.2106/JBJS.16.00244.
A potential cause of persistent groin pain after total hip arthroplasty is impingement of the iliopsoas tendon. Treatment options include conservative management, tenotomy, and acetabular revision, but the literature, to our knowledge, has been limited to small case series on each technique. We present a series of patients with iliopsoas impingement after total hip arthroplasty and evaluate efficacy and risk factors for success or failure of each treatment strategy.
Forty-nine patients treated at one institution for a diagnosis of iliopsoas impingement after primary total hip arthroplasty with hemispherical acetabular component and polyethylene bearing were retrospectively reviewed. Twenty-one patients underwent acetabular revision, 8 patients underwent tenotomy, and 20 patients had nonoperative management. The mean follow-up was 4 years. Anterior acetabular component prominence was measured on true lateral hip radiographs.
At the most recent follow-up, 10 patients (50%) in the nonoperative group had groin pain resolution compared with 22 patients (76%) in the operative group (p = 0.06). In patients with <8 mm of component prominence, tenotomy provided resolution of groin pain in 5 (100%) of 5 patients and a mean Harris hip score of 89 points. In patients with ≥8 mm of prominence, acetabular revision led to groin pain resolution in 12 (92%) of 13 patients compared with 1 (33%) of 3 patients treated with tenotomy (p = 0.07).
Nonoperative management of iliopsoas impingement led to groin pain resolution in 50% of patients. In patients with minimal acetabular component prominence, iliopsoas release provided a high rate of success. Acetabular revision was more predictable for groin pain resolution in patients with ≥8 mm of anterior component prominence.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
全髋关节置换术后持续腹股沟区疼痛的一个潜在原因是髂腰肌肌腱撞击。治疗选择包括保守治疗、肌腱切断术和髋臼翻修术，但据我们所知，相关文献仅限于每种技术的小病例系列。我们报告了一组全髋关节置换术后发生髂腰肌撞击的患者，并评估了每种治疗策略成功或失败的疗效及危险因素。
回顾性分析在一家机构接受治疗的49例患者，这些患者在初次全髋关节置换术后使用半球形髋臼组件和聚乙烯衬垫，诊断为髂腰肌撞击。21例患者接受了髋臼翻修术，8例患者接受了肌腱切断术，20例患者接受了非手术治疗。平均随访时间为4年。在髋关节正侧位X线片上测量髋臼组件前方突出情况。
在最近一次随访时，非手术组10例患者（50%）腹股沟区疼痛缓解，而手术组为22例患者（76%）（p = 0.06）。对于组件突出<8 mm的患者，肌腱切断术使5例患者中的5例（100%）腹股沟区疼痛缓解，平均Harris髋关节评分为89分。对于组件突出≥8 mm的患者，髋臼翻修术使13例患者中的12例（92%）腹股沟区疼痛缓解，而接受肌腱切断术的3例患者中只有1例（33%）缓解（p = 0.07）。
髂腰肌撞击的非手术治疗使50%的患者腹股沟区疼痛缓解。对于髋臼组件突出最小的患者，髂腰肌松解成功率较高。对于组件前方突出≥8 mm的患者，髋臼翻修术对腹股沟区疼痛缓解的预测性更强。
治疗性III级。有关证据水平的完整描述，请参阅作者须知。
