Di Benedetto Paolo, Niccoli Giuseppe, Magnanelli Stefano, Beltrame Alessandro, Gisonni Renato, Cainero Vanni, Causero Araldo
clinic of orthopaedics, University Hospital of Udine.
Acta Biomed. 2019 Jan 10;90(1-S):104-109. doi: 10.23750/abm.v90i1-S.8076.
Groin pain after hip arthroplasty (HA) ranges from 0.4% to 18.3%. Defining the cause of groin pain after HA can be difficult. Iliopsoas impingement (IPI) has been reported to be the underlying cause of groin pain in up to 4.4% of cases. The purpose of this study is to present arthroscopic surgical outcomes in the treatment of IPI after HA.
Between September 2013 and March 2018, 13 patients, 11 total hip arthroplasty (THA), 1 hip endoprosthesis and 1 total hip resurfacing affected by groin pain due to unceasing iliopsoas tendinopathy for impingement after HA were treated arthroscopically. The patients underwent to physical examination, blood analysis, hip X-rays, bone scintigraphy and CT assessment. We performed the arthroscopic OUT-IN access to hip joint in all patients. VAS scale, Harris Hip Score (HHS) and Medical Research Council (MRC) scale were performed before surgery and during follow up at 1-3-6-12 months.
After 10 months of mean follow-up, average HHS and MRC scale improved significantly from preoperatively to postoperatively. No complications arose in our case series.
Hip arthroscopy after hip arthroplasty is supported in the literature for a variety of indications. Hip arthroscopy is a viable and reproducible technique in treatment of IPI, being less invasive than the classic open technique. This simple arthroscopic release provides satisfactory results and preserves HA function. Moreover an arthroscopic OUT-IN access proves good clinical outcomes, few complications and iatrogenic lesions.
髋关节置换术（HA）后腹股沟疼痛的发生率在0.4%至18.3%之间。确定HA后腹股沟疼痛的原因可能具有挑战性。据报道，髂腰肌撞击（IPI）是高达4.4%的病例中腹股沟疼痛的潜在原因。本研究的目的是介绍HA后IPI的关节镜手术治疗结果。
2013年9月至2018年3月期间，对13例因HA后持续性髂腰肌肌腱病导致撞击而出现腹股沟疼痛的患者进行了关节镜治疗，其中11例行全髋关节置换术（THA），1例行髋关节假体置换术，1例行全髋关节表面置换术。患者接受了体格检查、血液分析、髋关节X线检查、骨闪烁显像和CT评估。所有患者均采用关节镜内外联合入路进入髋关节。术前及术后1、3、6、12个月进行视觉模拟评分（VAS）、Harris髋关节评分（HHS）和医学研究委员会（MRC）评分。
平均随访10个月后，平均HHS和MRC评分从术前到术后有显著改善。我们的病例系列中未出现并发症。
文献支持在多种适应证下进行髋关节置换术后的髋关节镜检查。髋关节镜检查是治疗IPI的一种可行且可重复的技术，比传统的开放技术侵入性更小。这种简单的关节镜下松解术能提供满意的结果并保留HA的功能。此外，关节镜内外联合入路显示出良好的临床效果、较少的并发症和医源性损伤。
