Department of Orthopaedic Surgery, NYU Langone Health, New York, NY, USA.
Orthopaedic Surgery, University of Ottawa, Ottawa, ON, Canada.
Hip Int. 2021 Jul;31(4):542-547. doi: 10.1177/1120700020908845. Epub 2020 Feb 24.
Iliopsoas tendinitis is a known source of extra-articular hip pain and it has been shown to be a common cause of continued hip pain following total hip arthroplasty. While iliopsoas tendinitis after hip arthroscopy is a well-known phenomenon amongst hip arthroscopists, its presentation, course, and treatment has yet to be elucidated.
An IRB-approved chart review was performed of patients undergoing hip arthroscopy for femoroacetabular impingement (FAI) between March 2015 and July 2017. No cases of dysplasia were included. All patients had combined cam/pincer impingement as well as labral pathology. Tendinitis patients were identified. Patient demographics, surgical data, time to onset/diagnosis of iliopsoas tendinitis, treatment (oral anti-inflammatories, corticosteroid injection, physical therapy), and resolution of symptoms were recorded. These cases were age- and sex-matched to a control group that did not develop postoperative iliopsoas tendinitis for comparison. Patient outcomes were measured with the modified Harris Hip Score (mHHS) and Nonarthritic Hip Score (NAHS) recorded from the preoperative and 1-year postoperative visits.
Of 258 hip arthroscopy cases, 18 cases (7.0%) of postoperative iliopsoas tendinitis were diagnosed under high resolution ultrasound. On average, iliopsoas tendinitis was diagnosed 2.8 ± 1.8 months after surgery. There were no significant differences in age, sex, and BMI between patients that developed IP tendinitis compared to those that did not. No specific procedures were found to be significantly associated with incidence of postoperative IP tendinitis, including capsular closure.18 patients were treated with corticosteroid injection, which provided mild to moderate improvement for 5 (27.8%) patients and completely resolved symptoms for 13 patients (72.2%). Of all 18 patients with postoperative iliopsoas tendinitis confirmed by response to a diagnostic injection, 10 (55.6%) had symptoms improve within 3 months of diagnosis, 2 (11.1%) between 3 and 6 months, 4 (22.2%) between 6 and 12 months, and 2 (11.1%) after 1 year. No patients went on to have surgery for this problem. Patients with iliopsoas tendinitis had lower MHHS ( 0.04) and NAHS ( = 0.09) scores at their 1-year postoperative visits.
Iliopsoas tendinitis is a common source of pain following arthroscopic hip surgery and can be effectively diagnosed and treated with ultrasound-guided injection. Therefore, surgeons performing arthroscopic procedures of the hip must remain aware of and include it in their differential when encountering patients with hip flexion pain after surgery. Research should be continued to further evaluate the long-term outcomes and return to sport rates of these patients.
髂腰肌肌腱炎是髋关节外关节痛的已知来源，并且已经证明它是髋关节置换术后髋关节持续疼痛的常见原因。虽然髋关节镜检查后髂腰肌肌腱炎在髋关节镜医师中是一种众所周知的现象，但它的表现、病程和治疗尚未阐明。
对 2015 年 3 月至 2017 年 7 月期间因股骨髋臼撞击症（FAI）接受髋关节镜检查的患者进行了一项经机构审查委员会批准的图表回顾。不包括发育不良的病例。所有患者均有凸轮/钳夹撞击和关节盂唇病变。确定了肌腱炎患者。记录患者的人口统计学、手术数据、髂腰肌肌腱炎发病/诊断的时间、治疗（口服消炎药、皮质类固醇注射、物理治疗）和症状缓解情况。这些病例与未发生术后髂腰肌肌腱炎的对照组进行了年龄和性别匹配，以进行比较。使用改良 Harris 髋关节评分（mHHS）和非关节炎髋关节评分（NAHS）从术前和术后 1 年随访来测量患者的预后。
在 258 例髋关节镜检查病例中，18 例（7.0%）通过高分辨率超声诊断为术后髂腰肌肌腱炎。平均而言，髂腰肌肌腱炎在手术后 2.8±1.8 个月被诊断出来。与未发生 IP 肌腱炎的患者相比，发生 IP 肌腱炎的患者在年龄、性别和 BMI 方面无显著差异。没有发现任何特定的手术程序与术后 IP 肌腱炎的发生率显著相关，包括囊封闭。18 例患者接受皮质类固醇注射治疗，5 例（27.8%）患者轻度至中度改善，13 例（72.2%）患者症状完全缓解。在所有 18 例经诊断性注射证实为术后髂腰肌肌腱炎的患者中，10 例（55.6%）在诊断后 3 个月内症状改善，2 例（11.1%）在 3 至 6 个月之间，4 例（22.2%）在 6 至 12 个月之间，2 例（11.1%）在 1 年后。没有患者因该问题接受手术。髂腰肌肌腱炎患者在术后 1 年的 mHHS（ 0.04）和 NAHS（ = 0.09）评分较低。
髂腰肌肌腱炎是髋关节镜手术后疼痛的常见原因，可通过超声引导注射有效诊断和治疗。因此，进行髋关节镜手术的外科医生在遇到术后髋关节屈曲疼痛的患者时，必须保持警惕，并将其纳入鉴别诊断。应继续进行研究，以进一步评估这些患者的长期预后和重返运动率。
