Quesada-Jimenez Roger, Schab Andrew R, Kahana-Rojkind Ady H, McCarroll Tyler R, Perets Itay, Domb Benjamin G
American Hip Institute Research Foundation, Chicago, Illinois, U.S.A.
American Hip Institute, Chicago, Illinois, U.S.A.; Hadassah Hebrew University Hospital, Jerusalem, Israel.
Arthroscopy. 2025 Jul;41(7):2394-2401. doi: 10.1016/j.arthro.2024.11.081. Epub 2024 Dec 2.
To report the minimum 2-year clinical outcomes of endoscopic iliopsoas fractional lengthening (IFL) in patients with recalcitrant iliopsoas tendinitis after total hip arthroplasty (THA).
Data were prospectively collected from 2014 to 2020 for patients who underwent IFL after primary THA as part of our institutional hip outcomes registry. Patients were included if they had completed the following patient-reported outcomes preoperatively and at minimum 2-year follow-up: modified Harris Hip Score and visual analog scale score. Preoperative and postoperative data were available for the International Hip Outcome Tool 12 score, and patient satisfaction was analyzed. Patients included in the study reported irritation of the iliopsoas tendon after cementless THA, refractory to conservative treatment methods. IFL was recommended after a workup that included ruling out infection and aseptic loosening, as well as a positive response to an iliopsoas guided diagnostic injection.
Seventeen patients were included in the study. The mean age at IFL was 56.42 years (range, 30.17-81.29 years). The mean interval between THA and IFL was 2.72 years (range, 0.25-8.34 years). There was a significant improvement in all evaluated patient-reported outcomes, and a high percentage of patients met the minimal clinically important difference for the modified Harris Hip Score (14, 82.35%), International Hip Outcome Tool 12 score (11, 91.66.00%), and visual analog scale score (16, 94.12%) (P < .05). Furthermore, 15 patients (88.2%) reported a positive response to the patient acceptable symptom state anchor question. No impact on preoperative versus postoperative active range of motion was observed, and no patient reported weakness at the latest follow-up (P > .05). Preoperative flexion was 106.33° (range, 85.0°-120.0°), and postoperative flexion was 106° (range, 90°-120°).
Endoscopic IFL yielded significant improvements in functional outcomes with high patient satisfaction at minimum 2-year follow-up, with no reported complications. This procedure did not have a significant negative impact on hip range of motion.
Level IV, retrospective case series.
报告全髋关节置换术（THA）后顽固性髂腰肌肌腱炎患者接受内镜下髂腰肌部分延长术（IFL）的至少2年临床疗效。
前瞻性收集2014年至2020年在我院接受初次THA后行IFL患者的数据，作为我院髋关节结局登记系统的一部分。如果患者术前及至少2年随访时完成了以下患者报告结局，则纳入研究：改良Harris髋关节评分和视觉模拟量表评分。可获得术前及术后国际髋关节结局工具12评分的数据，并分析患者满意度。纳入研究的患者报告在非骨水泥型THA后出现髂腰肌肌腱刺激，保守治疗方法无效。在包括排除感染和无菌性松动以及对髂腰肌引导诊断性注射有阳性反应的检查后，建议行IFL。
17例患者纳入研究。IFL时的平均年龄为56.42岁（范围30.17 - 81.29岁）。THA与IFL之间的平均间隔为2.72年（范围0.25 - 8.34年）。所有评估的患者报告结局均有显著改善，且高比例患者达到改良Harris髋关节评分（14例，82.35%）、国际髋关节结局工具12评分（11例，91.66%）和视觉模拟量表评分（16例，94.12%）的最小临床重要差异（P < 0.05）。此外，15例患者（88.2%）对患者可接受症状状态锚定问题回答为阳性。未观察到对术前与术后主动活动范围有影响，且在最近随访时无患者报告无力（P > 0.05）。术前屈曲度为106.33°（范围85.0° - 120.0°），术后屈曲度为l06°（范围90° - 120°）。
内镜下IFL在至少2年随访时功能结局有显著改善，患者满意度高，且未报告并发症。该手术对髋关节活动范围无显著负面影响。
IV级，回顾性病例系列。
