Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 6, 2020; 8(21): 5326-5333
Published online Nov 6, 2020. doi: 10.12998/wjcc.v8.i21.5326
Arthroscopic treatment of iliopsoas tendinitis after total hip arthroplasty with acetabular cup malposition: Two case reports
Heejae Won, Kwang-Hwan Kim, Jae-Wook Jung, Shin-Yoon Kim, Seung-Hoon Baek
Heejae Won, Kwang-Hwan Kim, Jae-Wook Jung, Shin-Yoon Kim, Seung-Hoon Baek, Department of Orthopedic Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-Gu, Daegu 41944, South Korea
Author contributions: Each author took part in the design of the study, contributed to acquisition of data, analysis and interpretation of data and agreed to accept equal responsibility for the accuracy of the content of the paper; all authors participated in drafting the article or revising it critically for important intellectual content and gave final approval of the version to be submitted and any revised version.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
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Corresponding author: Seung-Hoon Baek, MD, PhD, Associate Professor, Department of Orthopedic Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-Gu, Daegu 41944, South Korea. insideme@paran.com
Received: April 27, 2020
Peer-review started: April 27, 2020
First decision: September 24, 2020
Revised: October 6, 2020
Accepted: October 26, 2020
Article in press: October 26, 2020
Published online: November 6, 2020
Processing time: 193 Days and 0.8 Hours
Abstract
BACKGROUND

Optimal treatment for iliopsoas tendinitis after total hip arthroplasty (THA) with cup malposition, iliopsoas release alone or with cup revision, is controversial, particularly in young, active patients. Moreover, arthroscopic iliopsoas tendon (IPT) release in these patients has been rarely described, and midterm effects of this procedure on THA longevity and groin pain recurrence remain unclear. We performed arthroscopic IPT release after THA and report midterm outcomes in two young patients with acetabular cup malposition.

CASE SUMMARY

In the two patients, groin pain started early after THA. Physical examination revealed nonspecific findings, and laboratory tests showed no evidence of infection. Radiography and computed tomography showed reduced acetabular component anteversion angle and anterior cup prominence of more than 16 mm. For therapeutic diagnosis, ultrasonography-guided lidocaine with steroid was injected into the IPT sheath. In both patients, groin pain improved initially but worsened after a few months. Therefore, the patients underwent arthroscopic IPT release under spinal anesthesia. Arthroscopy revealed synovitis with fibrous tissues around the IPT and various lesions related to the implants after THA. IPT tenotomy and debridement with biopsy were performed; histopathologic studies showed chronic inflammation with synovial hyperplasia. Both patients were encouraged to start walking immediately after surgery, and they returned to complete daily function early after surgery. They experienced no recurrence of groin pain or any implant-related problems 5 years postoperatively.

CONCLUSION

Arthroscopic IPT release for cup malposition produced excellent midterm outcomes without recurrence of groin pain and implant-related problems.

Keywords: Iliopsoas tendinitis; Total hip arthroplasty; Cup malposition; Arthroscopy; Tenotomy; Case report

Core Tip: Optimal treatment for iliopsoas tendinitis combined with cup malposition is controversial. Ultrasonography-guided analgesic injection is useful in therapeutic diagnosis. If conservative treatment fails, cup revision or iliopsoas tendon (IPT) release with cup retention can be considered. Acetabular correction of malposition of well-fixed component might be ideal especially in young, active patients but is usually refused because of symptoms are subtle. Arthroscopic IPT release can provide better access to evaluate the exact location of lesions and other potential problems related to total hip arthroplasty and may be a useful alternative surgical option for preventing recurrence of groin pain.