Endoscopic Iliopsoas Fractional Lengthening After Total Hip Arthroplasty: Surgical Technique
Author(s):Quesada-Jimenez R, Kahana-Rojkind AH, Flynn ME, Wallace IA, Patel DH, Domb BG.
DOI Link: 10.1016/j.eats.2025.103579
Background
Persistent anterior hip pain after total hip arthroplasty (THA) is often due to iliopsoas tendinitis after exclusion of infection or implant-related causes. When conservative management fails, surgical release or lengthening may be indicated.
Methods
This article describes a technical surgical technique for endoscopic iliopsoas fractional lengthening performed after THA. Diagnosis is based on clinical evaluation, imaging, and confirmatory ultrasound-guided injection. The technique targets the musculotendinous junction to minimize strength loss.
Key Findings
- Presents a reproducible step-by-step endoscopic iliopsoas fractional lengthening technique
- Approach focuses on the musculotendinous junction
- Designed to reduce anterior hip pain while preserving hip flexion strength
- Highlights diagnostic pathway after exclusion of infection and loosening
- No outcome cohort data (technical note only)
Conclusion
Endoscopic iliopsoas fractional lengthening is a minimally invasive option for refractory iliopsoas tendinitis after THA, with a technique designed to minimize functional loss while addressing pain.
What Does This Mean for Providers?
This is a technical guide rather than an outcomes study. It provides a reproducible minimally invasive approach for managing post-THA iliopsoas irritation when nonoperative treatment fails.