title: The role of arthroscopy in the treatment of groin pain after total hip arthroplasty: our experience.
abstract: OBJECTIVE
  The purpose of the study was to present our arthroscopic surgical technique and the results in patient with pain after a hip replacement.
  
  
  METHODS
  Between November 2009 and September 2011, 35 patients with groin pain after total hip arthroplasty (THA) were treated arthroscopically. The patients underwent a preoperative examination consisting in careful history, physical examination, laboratory evaluation, diagnostic evaluation using x-rays and pelvis CT scans. In patients for whom the clinical picture suggested iliopsoas tendonitis, we also performed injection of local anaesthetic on the iliopsoas tendon sheath. All the patients were positioned in the supine decubitus position with traction applied, using 2 arthroscopic portals (AL, MID-A). An extensive debridement of adhesions, periprosthetic tissue and neocapsula were performed; when there were signs of iliopsoas impingement, a transcapsular tenotomy was performed according to Wettstein technique.
  
  
  RESULTS
  The average age was 57 (29-77) years old. The average time to onset of symptoms was 10.8 (5-15) months after THA. The average preoperative Harris Hip Score (HHS) was 44.1 (range 32-56). The average preoperative Medical Research Council (MRC) scale for muscle strenght was 3.27 (range 3-4). After 24 months of follow-up patients show an average HHS of 75.73 (range 50-91). Patients who underwent iliopsoas release show a postoperative HHS of 83.28 (range 61-91). The average postoperative MRC scale was 4.45.
  
  
  CONCLUSIONS
  Hip arthroscopy in treatment of reactive synovitis and adhesions shows good results according to literature. Hip arthroscopy in treatment of anterior iliopsoas impingement is the most useful instrument, being less invasive than the classic open technique.
authors.affiliation: Conservative Orthopaedic Surgery and Innovative Techniques, Rizzoli Orthopaedic Institute, Bologna - Italy.
authors.forename: Mattia
authors.initials: M
authors.lastname: Filanti
authors.affiliation: Conservative Orthopaedic Surgery and Innovative Techniques, Rizzoli Orthopaedic Institute, Bologna - Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Carubbi
authors.affiliation: Conservative Orthopaedic Surgery and Innovative Techniques, Rizzoli Orthopaedic Institute, Bologna - Italy.
authors.forename: Nicolandrea
authors.initials: N
authors.lastname: Del Piccolo
authors.affiliation: Conservative Orthopaedic Surgery and Innovative Techniques, Rizzoli Orthopaedic Institute, Bologna - Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Rani
authors.affiliation: Conservative Orthopaedic Surgery and Innovative Techniques, Rizzoli Orthopaedic Institute, Bologna - Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Mazzotta
authors.affiliation: Conservative Orthopaedic Surgery and Innovative Techniques, Rizzoli Orthopaedic Institute, Bologna - Italy.
authors.forename: Dante
authors.initials: D
authors.lastname: Dallari
mesh_terms: D000328:Adult; D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000379:methods; D001182:Arthroscopy / Q000379:methods; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006119:Groin; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D063806:Myalgia / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000000981:diagnostic imaging / Q000601:surgery*; D016658:Psoas Muscles / Q000503:physiopathology*; D012189:Retrospective Studies; D012380:Role; D058971:Tenotomy / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome