title: Hip pain and pseudo-lengthening of the leg due to iliopsoas haematoma following implantation of an uncemented component in acetabular cotyloplasty technique.
abstract: We report early symptomatic (groin pain and apparent limb lengthening) findings in our 12 consecutive patients who underwent total hip replacements using a cementless acetabular cotyloplasty technique. This report is the first in the literature to mention such an early complication in a large number of patients and also to describe early detection and treatment in these cases. During the period of January 2007 to December 2010, 12 patients (seven female, five male) with dysplastic hip underwent total hip arthroplasty. The mean age of the patients was 57 years (range 52-61 years) and the mean follow-up time was 18 months (12-36 months). A cotyloplasty technique was performed and uncemented acetabular and femoral components were implanted in all these 12 patients. All patients were reviewed postoperatively for clinical and radiographic assessment at six weeks, three months, six months, and one year, and then annually thereafter. During the first one to two months (mean time 22 ± 16 days), all patients complained of a constant pain in the groin that started in the early postoperative period. A pseudo lengthening of the operated hip and pelvic tilt was found on clinical examination at the three-month follow-up. The True length did not reveal a significant leg length discrepancy. Hip pain, pseudo lengthening, and pelvic tilt resolved within 123 ± 17 days post-op. A cotyloplasty technique using an uncemented acetabular implant can cause an intrapelvic hematoma of the iliopsoas muscle giving rise to temporary groin pain, pseudo lengthening on the operated side, and gait disturbances to the patient in the early postoperative period. Symptoms resolved completely in all of our cases. Iliopsoas physiotherapy could be useful and should be encouraged during the symptomatic period. Patients have to be informed during consenting and reassured about this symptomatology. Awareness of this likely complication would help surgeons to detect the problem and initiate treatment early.
authors.affiliation: Department of Orthopaedics, Prince Charles Hospital, Merthyr Tydfil, UK. aalexgr2000@yahoo.com
authors.forename: Alexandros P
authors.initials: AP
authors.lastname: Apostolopoulos
authors.forename: Raghavendra Prasad
authors.initials: RP
authors.lastname: Sidaginamale
authors.forename: B
authors.initials: B
authors.lastname: McConnell
authors.forename: A
authors.initials: A
authors.lastname: Manta
authors.forename: G
authors.initials: G
authors.lastname: Zafiropoulos
mesh_terms: D000077:Acetabulum / Q000601:surgery*; D018771:Arthralgia / Q000175:diagnosis / Q000209:etiology*; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006406:Hematoma / Q000150:complications* / Q000175:diagnosis; D006801:Humans; D007870:Leg Length Inequality / Q000150:complications* / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D009135:Muscular Diseases / Q000150:complications* / Q000175:diagnosis; D010149:Postoperative Pain / Q000175:diagnosis / Q000209:etiology*; D011475:Prosthesis Failure; D012189:Retrospective Studies