Endoscopic Iliopsoas Fractional Lengthening as a Treatment for Refractory Iliopsoas Impingement After Total Hip Arthroplasty Shows Favorable Functional Outcomes With No Impact on Range of Motion

Endoscopic Iliopsoas Fractional Lengthening as a Treatment for Refractory Iliopsoas Impingement After Total Hip Arthroplasty Shows Favorable Functional Outcomes With No Impact on Range of Motion

Authors: Quesada-Jimenez R, Schab AR, Kahana-Rojkind AH, McCarroll TR, Perets I, Domb BG

DOI Link:10.1016/j.arthro.2024.11.081

Journal:Arthroscopy, 2025

Objective:

To assess the safety and efficacy of endoscopic iliopsoas fractional lengthening (IFL) in managing iliopsoas impingement following total hip arthroplasty (THA).

Methodology:

A retrospective study of 17 patients with refractory iliopsoas tendinitis after THA, treated with IFL and followed for a minimum of 2 years. Outcomes were assessed using multiple PROMs and range-of-motion testing.

Key Findings:

• All PROMs showed statistically significant improvement postoperatively.
• 88.2% of patients achieved PASS criteria, indicating clinically meaningful recovery.
• No postoperative loss of hip range of motion or strength was observed.
• No major complications or revisions were reported during follow-up.

Conclusion:

Endoscopic IFL is a minimally invasive, effective treatment for iliopsoas-related pain after THA. It provides pain relief and functional gains without compromising hip mobility.

What Does This Mean for Providers?

For orthopedic surgeons managing post-THA groin pain due to iliopsoas impingement, this study supports endoscopic IFL as a safe and effective intervention. Importantly, the procedure does not compromise hip flexor strength or range of motion. Providers should consider IFL in patients who remain symptomatic despite conservative management, ensuring proper diagnosis via imaging and physical exam to rule out other causes of pain.