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Illiopsoas Tendon Release Following Total Hip Arthroplasty: Surgical Technique

February 19, 2016

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

This video describes the indications for, technique for, and a case report of iliopsoas tendon release after total hip arthroplasty. Although total hip arthroplasty is a highly effective procedure, iliopsoas tendon impingement is an important factor to consider in patients with postoperative groin pain exacerbated by flexion-extension activities. Most patients will require surgical treatment for adequate pain relief; however, nonsurgical treatment options must be exhausted before surgical treatment is considered. Injection of the iliopsoas tendon often affords temporary pain relief. Injections serve as a diagnostic and therapeutic intervention because their effectiveness may predict surgical success. Tendon release is successful in many patients, resulting in decreased pain immediately postoperatively and pain relief at 6 weeks postoperatively. Indications for iliopsoas tendon release include persistent pain after total hip arthroplasty in patients in whom nonsurgical treatment failed and in whom imaging studies do not demonstrate anterior overhang of the acetabular component of the total hip implant. This video describes the technique for tendon release, including portals used, tendon identification, tendon cutting, and postoperative management. After tendon release, surgeons must control pain, initiate physical therapy, and monitor range of motion at follow-up visits. Rates of recurrence in patients who undergo tendon release are low. To date, only small case series have been published; therefore, additional data should be collected before conclusions are drawn. With the proper clinical examination and imaging findings, iliopsoas tendon impingement after total hip arthroplasty is an important factor to consider, with tendon release offering most patients a good clinical outcome.