Iliopsoas Tendinitis after Hip Replacement Treatment Options

What is Iliopsoas tendinitis after total hip arthroplasty (THA)?

Iliopsoas tendinitis after total hip arthroplasty (THA) is a condition characterized by inflammation or irritation of the iliopsoas tendon, which can occur due to altered hip biomechanics, impingement, or component malpositioning following hip replacement surgery. Common symptoms include groin pain, anterior hip pain, or snapping sensations in the hip joint, often exacerbated by activities requiring hip flexion. Diagnosis typically involves a combination of clinical evaluation, imaging studies, and dynamic tests to assess tendon integrity and movement.

What treatment options are available?

Treatment of iliopsoas tendinitis after total hip arthroplasty (THA) aims to alleviate symptoms, improve hip function, and address underlying causes contributing to tendon irritation. The management approach typically involves a combination of conservative measures and, in refractory cases, surgical intervention.

Conservative treatment:

1. Rest and Activity Modification: Initial management focuses on reducing activities that exacerbate symptoms, such as prolonged hip flexion or repetitive movements that strain the iliopsoas tendon.
2. Physical Therapy: A tailored physical therapy program is essential to address muscle imbalances, improve hip joint mechanics, and strengthen surrounding muscles to support the hip joint. Therapeutic modalities such as ice, heat, ultrasound, and electrical stimulation may also help alleviate pain and inflammation.
3. Anti-inflammatory Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) or corticosteroid injections may be prescribed to reduce inflammation and alleviate pain associated with iliopsoas tendinitis.
4. Iliopsoas Tendon Injections: Ultrasound-guided or fluoroscopy-guided corticosteroid injections directly into the iliopsoas tendon or surrounding bursae may provide targeted relief of inflammation and pain.
5. Surgical Treatment: If conservative measures fail to provide adequate symptom relief, surgical intervention may be considered. Surgical options for iliopsoas tendinitis after THA may include:
6. Iliopsoas Tendon Release: Surgical release of the iliopsoas tendon aims to alleviate tension and irritation by partially or completely cutting the tendon. This procedure may be performed arthroscopically or through an open approach, depending on the extent of tendon involvement and surgeon preference.
7. Component Revision: In cases where component malpositioning or impingement contributes to iliopsoas tendonitis, revision total hip arthroplasty (THA) may be necessary to correct structural abnormalities and restore normal hip biomechanics. This may involve adjusting the position of the acetabular or femoral components, changing implant size or design, or addressing leg length discrepancy.

What does the rehabilitation entail?

Following treatment for iliopsoas tendinitis after THA, rehabilitation plays a crucial role in optimizing outcomes and restoring hip function. Physical therapy focuses on improving hip muscle strength, flexibility, and neuromuscular control while minimizing stress on the iliopsoas tendon and surrounding soft tissues. Rehabilitation protocols may include progressive strengthening exercises, flexibility training, gait training, and functional activities to facilitate a safe return to activities of daily living and recreational pursuits.

Overall, the treatment of iliopsoas tendinitis after THA requires a comprehensive and individualized approach, considering patient-specific factors, severity of symptoms, underlying pathology, and response to conservative measures. Close collaboration between the patient, orthopedic surgeon, and physical therapist is essential to achieve optimal outcomes and facilitate a successful recovery.

Dr. Shane J. Nho is a board-certified fellowship trained sports medicine orthopaedic surgeon who specializes in the treatment of iliopsoas tendinitis after hip replacement. If you believe you are affected by iliopsoas tendinitis after hip replacement, schedule a consultation today with our experienced orthopaedic care team.