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[Irritation of the iliopsoas tendon after total hip arthroplasty]

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BORIS DOI
10.7892/boris.24446
Date of Publication
2007
Publication Type
Article
Division/Institute

Universitätsklinik fü...

Author
Hessmann, M H
Hübschle, L
Tannast, Moritz
Universitätsklinik für Orthopädische Chirurgie
Siebenrock, Klaus-Arno
Universitätsklinik für Orthopädische Chirurgie
Ganz, Reinhold
Universitätsklinik für Orthopädische Chirurgie
Series
Orthopäde
ISSN or ISBN (if monograph)
0085-4530
Publisher
Springer-Verlag
Language
German
Publisher DOI
10.1007/s00132-007-1094-3
PubMed ID
17541541
Description
Chronic irritation of the iliopsoas tendon is a rare cause of persistent pain after total joint replacement of the hip. In the majority of cases, pain results from a mechanical conflict between the iliopsoas tendon and the anterior edge of the acetabular cup after total hip arthroplasty. Pain can be reproduced by active flexion of the hip and by active raising of the straightened leg. In addition, painful leg raising against resistance and passive hyperextension are suggestive of an irritation of the iliopsoas tendon. Symptoms evolve from a mechanical irritation of the iliopsoas tendon and an oversized or retroverted acetabular cup, screws penetrating into the inner aspect of the ilium, or from bone cement protruding beyond the anterior acetabular rim. The diagnosis may be assumed on conventional radiographs and confirmed by CT scans. Fifteen patients with psoas irritation after total hip replacement are reported on. Eleven patients were treated surgically. The acetabular cup was revised and reoriented with more anteversion in six patients, isolated screws penetrating into the tendon were cut and leveled in three patients, and prominent bone cement in conflict with the tendon was resected once. A partial release of the iliopsoas tendon only was performed in another patient. Follow-up examination (range: 11-89 months) revealed that nine patients were free of pain and two patient had mild residual complaints. Psoas irritation in combination with total hip replacement can be prevented by a correct surgical technique, especially with proper selection of the cup size and insertion of the acetabular cup avoiding a rim position exceeding the level of the anterior acetabular rim.
Handle
https://boris-portal.unibe.ch/handle/20.500.12422/98065
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132_2007_Article_1094.pdftextAdobe PDF686.39 KBpublisherpublishedOpen
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