Arthroscopic Diagnosis and Treatment of Chronic Hip Pain After Total Hip Arthroplasty and the Role of Anterior Capsule Disruption in Iliopsoas Tendinopathy.

BACKGROUND

The use of hip arthroscopic surgery in patients suffering from chronic hip pain after total hip arthroplasty (THA) has a limited presence in the literature, with most studies having limited follow-up.

PURPOSE

The first goal of this study was to evaluate hip arthroscopic surgery in the diagnosis and management of patients with chronic hip pain after THA. The second goal was to describe a new cause of iliopsoas tendinopathy (IPT) involving disruption of the anterior capsule.

STUDY DESIGN

Case series; Level of evidence, 4.

METHODS

We conducted a retrospective analysis with prospectively collected clinical outcomes of patients after THA who underwent hip arthroscopic surgery for chronic hip pain without an identifiable cause. The patients were at least 18 years old and had a minimum follow-up of 24 months.

RESULTS

The retrospective analysis found that hip arthroscopic surgery led to new diagnostic information in 8 patients (80%). Of the 10 patients diagnosed with IPT, 4 (40%) lacked an anatomic cause; however, these patients had a history of difficult exposure of the anterior capsule and/or a lack of capsular repair during index THA. The mean modified Harris Hip Score (mHHS) was 71.9 ± 15.6, and the mean 6-month postoperative visual analog scale (VAS) pain score was 0.8 ± 2.2, which was significantly lower than preoperatively (

CONCLUSION

Hip arthroscopic surgery was found to have an important role in the diagnostic and therapeutic management of patients with chronic hip pain after THA, with good clinical outcomes at a mean follow-up of 6.8 years and no complications. We believe that disruption of the anterosuperior acetabular capsule, including the reflected head of the rectus femoris, can allow the iliopsoas tendon to move intra-articularly and precipitate IPT. This disruption may be appreciated on the SLR strength test. Although this study presents a small sample size that cannot substantiate a cause-effect relationship, orthopaedic surgeons performing THA should consider minimizing disruption and/or ensuring repair of the anterior capsule to decrease this potential cause of IPT.

Déclaration de conflit d'intérêts

One or more of the authors has declared the following potential conflict of interest or source of funding: This study was supported by the Conine Family Fund for Joint Preservation. S.D.M. has received hospitality payments from Smith & Nephew and Kairos Surgical, has received educational support from Kairos Surgical, and has received research funding from Smith & Nephew. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.