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Illiopsoas Tendon Release following Total Hip Arthroplasty: Surgical Technique

February 19, 2016

Contributors: Devin Collins, BA; Oliver Fowler, BS, MS; Dominic S Carreira, MD; Dominic S Carreira, MD

This video describes the indications, technique, and a case report for an iliopsoas tendon release following total hip arthroplasty. Although total hip replacements are highly efficacious procedures, iliopsoas tendon impingement is an important differential to consider in patients presenting postoperatively complaining of groin pain that is exacerbated by flexion-extension activities. Most patients will require surgical intervention to achieve adequate pain relief, but it is important to exhaust conservative options first. Injection of the iliopsoas tendon will often provide temporary relief. Injections serve as both a diagnostic and therapeutic intervention as the effectiveness can be predictive of surgical success. Tendon release has proven to be successful with many patients reporting decreased pain immediately after the procedure and more patients reporting pain relief at six weeks postoperative. Indications for iliopsoas tendon release include persistent pain after a total hip arthroplasty after conservative measures have failed and when imaging does not demonstrate anterior overhang of the acetabular component of the total hip replacement. This video describes the technique for tendon release including portals used, identifying the tendon, cutting the tendon, and postoperative management. Following tendon release it is important to control pain, initiate physical therapy, and monitor range of motion in follow-up visits. Rates of recurrence in patients undergoing tendon release remain low. However, only small case series have been published to date and more data should be collected before conclusions are drawn. With the proper clinical exam and findings, iliopsoas tendon impingement following total hip replacement should be an important differential to consider with tendon release offering most patients a good clinical outcome.

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