[Anterior iliopsoas impingement after total hip arthroplasty: diagnosis and conservative treatment in 9 cases]

摘要: Purpose of the study Impingement iliopsoas muscle due to a protruding acetabular component is an uncommon cause pain after total hip arthroplasty. Diagnostic signs may be misleading and therapeutic management has varied, leading divergent findings reported in literature. The purpose this prospective work was determine frequency groin impingement (with or without identified causal mechanism) patients with painful arthroplasties identify diagnostic criteria that can used appropriate strategy. Material methods This conducted between 1998 2000 included 206 arthroplasties. From series, we excluded cases where related loosening (139 cases, 67%), infection (45 21.7%), bursitis on trochanteric sutures (2 1%), aortic aneurysm gluteal claudication resulting from lumbosacral disorder (10 4.8%). left 9 (4.3%) clinical picture suggestive impingement. These (mean age 50 years, range 38 - 65) had 8 uncemented press-fix cups 1 cemented cup mesh. Mean delay development arthroplasty procedure 7.3 months (1 48 months). most sign triggered by active flexion against force arc measuring 30 degrees 70 degrees. None these any material puncture aspiration ruled out infection. final diagnosis confirmed sedation extra-articular infiltration at anterior border (overhanging 6/9 cases) under computed tomographic guidance. Results Infiltrations xylocaine long-release corticosteroids led complete 4 partial other. Recurrent terminal tenotomy patients, provided 3 1. In all, successful relief achieved 7 cases: (repeated tenotomy. At last follow-up physical examination not loss force. Discussion conclusion Irritation 4.3% experiencing symptom onset variable but there appears pain-free period implantation. An anatomic element (anterior overhang) necessary for since test positive factor. important should first measure taken. We success cases. Tenotomy indicated case recurrence, providing cure our series. Cure changing simple even overhanging (6 cases). elective might if specific anomaly (overly long screw, cement leakage) screwed cup. however performed beforehand confirm diagnosis.