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Arthroscopic Iliopsoas Tenotomy for Management of Snapping Hip After Total Hip Arthroplasty

March 01, 2020

Contributors: Dylan Lowe, MD; Robert J Meislin, MD, FAAOS; Mikhail Zusmanovich, MD

Background Iliopsoas snapping and tendonitis after total hip arthroplasty is a complex problem affecting many patients, resulting in substantial pain and disability and necessitating activity modifications. The pathogenesis of iliopsoas snapping and tendonitis after total hip arthroplasty may include acetabular cup malpositioning, screw prominence, limb-length discrepancy, and extruded cement, all of which increase tension and wear on the iliopsoas tendon. Several surgical and nonsurgical treatment options have been described for the management of iliopsoas snapping after total hip arthroplasty. Although open surgical procedures have been the preferred treatment option, arthroscopic procedures are associated with improved outcomes, decreased complications, and improved postoperative rehabilitation. Purpose This video demonstrates a technique for arthroscopic intracapsular tenotomy of the iliopsoas tendon for the management of iliopsoas snapping after total hip arthroplasty. Methods The video provides an overview on the pathogenesis, diagnosis, and management of iliopsoas snapping after total hip arthroplasty. The video discusses the case presentation of a 49-year-old man with iliopsoas snapping after total hip arthroplasty who underwent arthroscopic intracapsular tenotomy of the tendon. Results Full débridement and complete release of the iliopsoas tendon were performed. The patient was advanced through a standardized rehabilitation protocol, which resulted in maintained relief of symptoms an considerable improvements in activity-related pain. Conclusion Arthroscopic débridement and tenotomy is a viable and safe option for the management of iliopsoas impingement and snapping after total hip arthroplasty in patients in whom nonsurgical treatment fails. Although studies report good to excellent outcomes in patients who undergo arthroscopic intracapsular iliopsoas tenotomy, results are contingent on careful and consistent technique and proper patient selection.