Lyon Ortho Clinic, clinique de la Sauvegarde, 29B, avenue des Sources, 69009 Lyon, France.
Lyon Ortho Clinic, clinique de la Sauvegarde, 29B, avenue des Sources, 69009 Lyon, France.
Orthop Traumatol Surg Res. 2017 Dec;103(8S):S207-S214. doi: 10.1016/j.otsr.2017.09.007. Epub 2017 Sep 13.
Impingement between the acetabular component and the iliopsoas tendon is a cause of anterior pain after total hip replacement (THR). Treatment can be non-operative, endoscopic or arthroscopic, or by open revision of the acetabular component. Few studies have assessed these options. The present study hypothesis was that endo/arthroscopic treatment provides rapid pain relief with a low rate of complications.
A prospective multicenter study included 64 endoscopic or arthroscopic tenotomies for impingement between the acetabular component and the iliopsoas tendon, performed in 8 centers. Mean follow-up was 8months, with a minimum of 6months and no loss to follow-up. Oxford score, patient satisfaction, anterior pain and iliopsoas strength were assessed at last follow-up. Complications and revision procedures were collated. Forty-four percent of patients underwent rehabilitation.
At last follow-up, 92% of patients reported pain alleviation. Oxford score, muscle strength and pain in hip flexion showed significant improvement. The complications rate was 3.2%, with complete resolution. Mean hospital stay was 0.8 nights. In 2 cases, arthroscopy revealed metallosis, indicating revision of the acetabular component. The only predictive factor was acetabular projection on oblique view. Rehabilitation significantly improved muscle strength.
Endoscopic or arthroscopic tenotomy for impingement between the acetabular component and the iliopsoas tendon following THR significantly alleviated anterior pain in more than 92% of cases. The low complications rate makes this the treatment of choice in case of failure of non-operative management. Arthroscopy also reorients diagnosis in case of associated joint pathology. Projection of the acetabular component on preoperative oblique view is the most predictive criterion, guiding treatment.
全髋关节置换术后（THR），髋臼组件与腰大肌腱撞击是导致前侧疼痛的一个原因。治疗方法可以是非手术、内镜或关节镜下治疗，也可以通过开放修复髋臼组件。很少有研究评估这些选择。本研究的假设是，内镜/关节镜治疗可迅速缓解疼痛，且并发症发生率低。
一项前瞻性多中心研究纳入了 8 家中心的 64 例髋臼组件与腰大肌腱撞击的内镜或关节镜下肌腱切断术。平均随访 8 个月，随访时间至少为 6 个月，无失访。末次随访时评估牛津评分、患者满意度、前侧疼痛和腰大肌力量。同时收集并发症和翻修手术的情况。44%的患者接受了康复治疗。
末次随访时，92%的患者报告疼痛缓解。牛津评分、肌肉力量和髋关节屈曲疼痛均有显著改善。并发症发生率为 3.2%，均完全缓解。平均住院时间为 0.8 晚。在 2 例中，关节镜检查显示有金属沉着症，提示髋臼组件需要翻修。唯一的预测因素是斜位片上髋臼的投影。康复治疗可显著改善肌肉力量。
THR 后髋臼组件与腰大肌腱撞击的内镜或关节镜下肌腱切断术可显著缓解 92%以上病例的前侧疼痛。低并发症发生率使该方法成为非手术治疗失败后的首选治疗方法。关节镜还可以重新确定与关节病变相关的诊断。术前斜位片上髋臼的投影是最具预测性的标准，指导治疗。
