Service de chirurgie orthopédique et traumatologique, CHU de Lille, 2, avenue Émile-Laine, 59000 Lille, France; Université Lille-Hauts de France, 59000 Lille, France.
Lyon Ortho Clinic, 29B, avenue des Sources, 69009 Lyon, France.
Orthop Traumatol Surg Res. 2023 Dec;109(8S):103687. doi: 10.1016/j.otsr.2023.103687. Epub 2023 Sep 17.
The occurrence of iliopsoas impingement (IPI) after total hip arthroplasty (THA) is a proven risk factor for negative outcomes. Endoscopic or arthroscopic tenotomies of the iliopsoas offer a surgical solution with short-term results that have already been validated in prospective multicenter series. We carried out a review of the patients at more than 5 years of follow-up in order to assess the stability of the results over time.
Our main hypothesis was that endoscopic/arthroscopic tenotomies allow stable medium-term resolution of the painful symptoms of IPI. Our secondary hypothesis was that medium-term survival was satisfactory.
This study is a continuation of a multicenter prospective series. Patients were contacted through multiple channels in order to: obtain an Oxford score, assess for satisfaction, psoas irritation, and daily pain on a visual analogue scale (VAS).
Of 64 patients in the original study, 57 were contacted. The Oxford score at the last follow-up was 40.7±7.7 [12-48]. There was a significant difference between the Oxford scores preoperatively, at 8 months and at the last follow-up. The mean satisfaction out of 10 was 8.0±2.1 [1-10]. We found 84% satisfaction at 5 years against 83% at 8 months. The VAS was 2.1±2.3 [0-10]. A straight leg psoas sign was present in 19.6% (10/51) of patients at 5 years, compared to 15.6% (8/51) at 8 months. The sign disappeared in four cases, while it reappeared during the interval in six cases. Survival was 91.2% (95% CI: 80.2-96.3) at 5 years.
Endoscopic/arthroscopic iliopsoas tenotomies represent a permanent medium-term solution to treat IPI after THA. The existence of a force differential or an acetabular overhang does not seem, within a certain limit, to impact the results in the medium term.
IV; prospective series without control group.
全髋关节置换术后发生髂腰肌撞击（IPI）是导致不良结局的一个已证实的危险因素。髂腰肌内镜或关节镜下切开术是一种有手术解决方案，其短期结果已在前瞻性多中心系列研究中得到验证。我们对随访时间超过 5 年的患者进行了回顾，以评估结果随时间的稳定性。
我们的主要假设是，内镜/关节镜下切开术可以稳定地缓解 IPI 的疼痛症状，达到中期缓解。我们的次要假设是，中期生存率令人满意。
这项研究是一项多中心前瞻性系列研究的延续。通过多种渠道联系患者，以获得牛津评分、评估满意度、髂腰肌刺激和视觉模拟量表（VAS）上的日常疼痛。
在最初的研究中，有 64 名患者，其中 57 名被联系到。末次随访时的牛津评分为 40.7±7.7[12-48]。术前、8 个月和末次随访时的牛津评分有显著差异。满意度平均为 10 分中的 8.0±2.1[1-10]。我们发现 5 年时的满意度为 84%，8 个月时为 83%。VAS 为 2.1±2.3[0-10]。5 年后，51 例患者中有 19.6%（10/51）存在直腿髂腰肌征，8 个月时有 15.6%（8/51）。该体征在 4 例中消失，而在 6 例中在随访期间再次出现。5 年时的生存率为 91.2%（95%CI：80.2-96.3）。
全髋关节置换术后发生 IPI 时，内镜/关节镜下髂腰肌切开术是一种永久性的中期治疗方法。在一定范围内，力差或髋臼突出似乎不会对中期结果产生影响。
IV；无对照组的前瞻性系列研究。
