Outcomes of Nonoperative Management, Iliopsoas Tenotomy, and Revision Arthroplasty for Iliopsoas Impingement after Total Hip Arthroplasty: A Systematic Review
Authors: Shapira J, Chen SL, Wojnowski NM, Lall AC, Rosinsky PJ, Maldonado DR, Domb BG
DOI: 10.1016/j.arth.2019.04.067
Background:
- Iliopsoas impingement (IPI) is a cause of groin pain after total hip arthroplasty (THA).
- Treatment options include nonoperative care, iliopsoas tenotomy, or revision arthroplasty, but comparative data are limited.
Methods:
- Systematic review of 11 studies encompassing 280 hips treated for IPI.
- Compared patient-reported outcomes (PROs) across management strategies.
Key Findings:
- Iliopsoas tenotomy provided better functional outcomes than nonoperative care.
- While revision surgery also improved symptoms, it had a higher complication rate.
Conclusions:
- Iliopsoas tenotomy is a safe and effective intermediate step before considering revision arthroplasty for IPI after THA.
What Does This Mean for Providers?
- Iliopsoas tenotomy should be considered as a first-line surgical intervention in patients with persistent IPI symptoms post-THA.
- Revision surgery should be reserved for refractory cases, given its higher complication risk.
- Accurate diagnosis of IPI and appropriate patient selection are critical to successful treatment planning.