title: Iliopsoas Impingement After Primary Total Hip Arthroplasty: Operative and Nonoperative Treatment Outcomes.
abstract: BACKGROUND
  A potential cause of persistent groin pain after total hip arthroplasty is impingement of the iliopsoas tendon. Treatment options include conservative management, tenotomy, and acetabular revision, but the literature, to our knowledge, has been limited to small case series on each technique. We present a series of patients with iliopsoas impingement after total hip arthroplasty and evaluate efficacy and risk factors for success or failure of each treatment strategy.
  
  
  METHODS
  Forty-nine patients treated at one institution for a diagnosis of iliopsoas impingement after primary total hip arthroplasty with hemispherical acetabular component and polyethylene bearing were retrospectively reviewed. Twenty-one patients underwent acetabular revision, 8 patients underwent tenotomy, and 20 patients had nonoperative management. The mean follow-up was 4 years. Anterior acetabular component prominence was measured on true lateral hip radiographs.
  
  
  RESULTS
  At the most recent follow-up, 10 patients (50%) in the nonoperative group had groin pain resolution compared with 22 patients (76%) in the operative group (p = 0.06). In patients with <8 mm of component prominence, tenotomy provided resolution of groin pain in 5 (100%) of 5 patients and a mean Harris hip score of 89 points. In patients with ≥8 mm of prominence, acetabular revision led to groin pain resolution in 12 (92%) of 13 patients compared with 1 (33%) of 3 patients treated with tenotomy (p = 0.07).
  
  
  CONCLUSIONS
  Nonoperative management of iliopsoas impingement led to groin pain resolution in 50% of patients. In patients with minimal acetabular component prominence, iliopsoas release provided a high rate of success. Acetabular revision was more predictable for groin pain resolution in patients with ≥8 mm of anterior component prominence.
  
  
  METHODS
  Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: 1Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Brian P
authors.initials: BP
authors.lastname: Chalmers
authors.forename: Peter K
authors.initials: PK
authors.lastname: Sculco
authors.forename: Rafael J
authors.initials: RJ
authors.lastname: Sierra
authors.forename: Robert T
authors.initials: RT
authors.lastname: Trousdale
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Berry
mesh_terms: D015746:Abdominal Pain / Q000209:etiology / Q000601:surgery; D000368:Aged; D000465:Algorithms; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D005260:Female; D057925:Femoracetabular Impingement / Q000209:etiology* / Q000601:surgery; D006801:Humans; D008297:Male; D010149:Postoperative Pain / Q000209:etiology / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology / Q000628:therapy; D016658:Psoas Muscles / Q000601:surgery; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D058971:Tenotomy / Q000379:methods; D016896:Treatment Outcome