Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Department of Orthopedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea.
J Arthroplasty. 2023 Aug;38(8):1621-1627. doi: 10.1016/j.arth.2023.01.037. Epub 2023 Jan 30.
Iliopsoas tendinopathy (IPT) can cause persistent groin pain and lead to dissatisfaction after total hip arthroplasty (THA). This study aimed to report the characteristics, incidences, risk factors, and treatment outcomes of IPT after THA.
We reviewed primary THAs performed at a single institution between January 2012 and May 2018. Clinical and radiographic analyses were performed on 1,602 THAs (1,370 patients). Patient characteristics, component sizes, inclination and anteversion angles, and antero-inferior cup prominence (≥8 millimeters (mm)), were compared between the groups with and without IPT. Changes in teardrop to lesser trochanter distance were measured to estimate changes in leg length and horizontal offset caused by THA. Logistic regression models were used to identify the risk factors for IPT. IPT was identified in 53 hips (3.3%).
Patients with IPT had greater leg lengthening (12.3 versus 9.3 mm; P = .001) and higher prevalence of antero-inferior cup prominence (5.7 versus 0.4%; P = .002). There was no significant difference in inclination, anteversion, and horizontal offset change between the two groups. In multivariate analyses, greater leg lengthening, prominent acetabular cup, women, and higher body mass index were associated with IPT. All patients reported improvement in groin pain after arthroscopic tenotomy, while 35.7% with nonoperative management reported improvement (P < .001).
Symptomatic IPT occurred in 53 (3.3%) of the 1,602 primary THAs. Our findings suggest that leg lengthening as well as prominent acetabular cup in THAs can be associated with the development of IPT. Arthroscopic tenotomy was effective in relieving groin pain caused by IPT.
髂腰肌肌腱病（IPT）可导致髋关节置换术后持续的腹股沟疼痛，并导致患者不满意。本研究旨在报告髋关节置换术后 IPT 的特征、发生率、风险因素和治疗结果。
我们回顾了一家机构在 2012 年 1 月至 2018 年 5 月期间进行的初次髋关节置换术。对 1370 名患者的 1602 例髋关节置换术进行了临床和影像学分析。比较了有 IPT 和无 IPT 两组患者的患者特征、组件大小、倾斜和前倾角、前下杯突出（≥8 毫米（mm））。测量泪滴至小转子距离的变化，以估计髋关节置换术引起的下肢长度和水平偏移的变化。使用逻辑回归模型确定 IPT 的风险因素。53 髋（3.3%）被诊断为 IPT。
IPT 患者下肢延长程度更大（12.3 毫米比 9.3 毫米；P =.001），前下杯突出的发生率更高（5.7%比 0.4%；P =.002）。两组之间的倾斜度、前倾角和水平偏移变化无显著差异。多变量分析显示，下肢延长程度较大、髋臼杯突出、女性和较高的体重指数与 IPT 相关。所有接受关节镜下肌腱切开术的患者均报告腹股沟疼痛改善，而接受非手术治疗的患者中 35.7%（P <.001）报告疼痛改善。
在 1602 例初次髋关节置换术中，有 53 例（3.3%）发生症状性 IPT。我们的研究结果表明，髋关节置换术中下肢延长程度以及髋臼杯突出与 IPT 的发生有关。关节镜下肌腱切开术可有效缓解 IPT 引起的腹股沟疼痛。
