Endoscopic Iliopsoas Fractional Lengthening as a Treatment for Refractory Iliopsoas Impingement After Total Hip Arthroplasty Shows Favorable Functional Outcomes With No Impact on Range of Motion.

PURPOSE: To report the minimum 2-year clinical outcomes of endoscopic iliopsoas fractional lengthening (IFL) in patients with recalcitrant iliopsoas tendinitis after total hip arthroplasty (THA).

METHODS

Data were prospectively collected from 2014 to 2020 for patients who underwent IFL after primary THA as part of our institutional hip outcomes registry. Patients were included if they had completed the following patient-reported outcomes preoperatively and at minimum 2-year follow-up: modified Harris Hip Score and visual analog scale score. Preoperative and postoperative data were available for the International Hip Outcome Tool 12 score, and patient satisfaction was analyzed. Patients included in the study reported irritation of the iliopsoas tendon after cementless THA, refractory to conservative treatment methods. IFL was recommended after a workup that included ruling out infection and aseptic loosening, as well as a positive response to an iliopsoas guided diagnostic injection.

RESULTS

Seventeen patients were included in the study. The mean age at IFL was 56.42 years (range, 30.17-81.29 years). The mean interval between THA and IFL was 2.72 years (range, 0.25-8.34 years). There was a significant improvement in all evaluated patient-reported outcomes, and a high percentage of patients met the minimal clinically important difference for the modified Harris Hip Score (14, 82.35%), International Hip Outcome Tool 12 score (11, 91.66.00%), and visual analog scale score (16, 94.12%) (P < .05). Furthermore, 15 patients (88.2%) reported a positive response to the patient acceptable symptom state anchor question. No impact on preoperative versus postoperative active range of motion was observed, and no patient reported weakness at the latest follow-up (P > .05). Preoperative flexion was 106.33° (range, 85.0°-120.0°), and postoperative flexion was 106° (range, 90°-120°).

CONCLUSIONS

Endoscopic IFL yielded significant improvements in functional outcomes with high patient satisfaction at minimum 2-year follow-up, with no reported complications. This procedure did not have a significant negative impact on hip range of motion.

LEVEL OF EVIDENCE: Level IV, retrospective case series.