Surgical Management of Iliopsoas Impingement With Combined Acetabular Revision and Partial Psoas Tenotomy

Background Persistent groin pain after total hip arthroplasty (THA) can result from iliopsoas impingement (IPI) on the acetabular rim. Controversy exists over the risks and benefits of tenotomy versus revision as a surgical solution. We report our limited experience with combined acetabular revision and partial iliopsoas tenotomy when other conservative treatments have failed. Methodology A total of eight patients revised for IPI by a single surgeon at a single institution were retrospectively reviewed after a minimum one-year follow-up. Preoperatively, all patients had prolonged groin pain for a mean of two years (range: 1-4 years) and had failed conservative treatment for at least six months. All patients underwent acetabular revision through a direct anterior approach (DAA) with partial psoas tendon release. No stems were revised. Dislocations, complications, and clinical outcomes are reported in this study. Results Of the eight patients, seven had a positive diagnostic challenge with an image-guided injection. All revised cups showed radiographic evidence of IPI with relative acetabular retroversion by either a cross-table lateral film or computed tomography scan. Preoperatively, the mean cup anteversion was 4 degrees (range: 0-9 degrees). Postoperatively, the mean cup anteversion was 19 degrees (range: 16-21 degrees). All cups were within the so-called safe zone. To avoid overstuffing, the mean cup size remained unchanged. There were no major postoperative complications. At a mean time to follow-up of 3.3 years, the mean Hip disability and Osteoarthritis Outcome Score for Joint Replacement was 75 points (range: 32-100 points). Conclusion IPI may be effectively managed with combined acetabular revision and tenotomy. The challenges of implant placement and positioning may be aided with intraoperative imaging through a DAA THA.