Ultrasound-guided Tenotomy and Osteectomy for the Treatment of Iliopsoas Impingement Post-total Hip Replacement

IF 0.2 Q4 ORTHOPEDICS Techniques in Orthopaedics Pub Date : 2021-12-21 DOI:10.1097/BTO.0000000000000578
Roland Z. White, Anitha L Thalluri, J. Cabot, M. Sampson
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引用次数: 0

Abstract

I liopsoas impingement is a common cause of groin pain posttotal hip replacement (THR) and has a reported incidence as high as 8.3%.1 Iliopsoas impingement causes ill-defined groin pain which is worsened by active hip flexion. Pain exacerbated by activities such as walking up stairs and lifting the leg in and out of a motor vehicle can be helpful diagnostic clues. The most common site of impingement is at the acetabular cup where there is friction with the deep aspect of the iliopsoas tendon. The iliopsoas tendon is positioned immediately anterior to the hip, separated from the capsule only by the iliopsoas bursa. Causes of impingement include bony excrescence, cement extrusion, a Rouviere’s sulcus, inadequate implant anteversion, or projecting studs or screws, excessive size of reinforcement ring, or by an increase in hip offset or hip length ≥ 1 cm.1 We describe iliopsoas tendon impingement secondary to bony excrescence. Conservative management of iliopsoas tendon impingement includes ultrasound (US)-guided anesthetic/corticosteroid injections, activity modification and nonsteroidal anti-inflammatory medications are often initially trialed. After conservative management options fail, surgical alternatives such as open or arthroscopic psoas tenotomy and revision hip arthroplasty can reliably improve the patient’s symptoms. Open surgical procedures however carry a higher risk of infection, accrue longer hospital and recovery periods,2 and arthroscopic procedures have increased risk of neurovascular damage. The use of US is gaining traction in orthopedic procedures, with some utilizing its benefits for placement of portal placement in hip arthroscopies.3 We propose US-guided tenotomy and ostectomy for management of ilipsoas impingement post-THR as it provides a less invasive option with reduced hospital stay and recovery time. TECHNIQUE
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超声引导下肌腱切开术和截骨术治疗全髋关节置换术后髂腰肌撞击
腰肌撞击是全髋关节置换术后腹股沟疼痛的常见原因,据报道其发生率高达8.3%髂腰肌撞击引起不明确的腹股沟疼痛,主动髋关节屈曲会使疼痛恶化。爬楼梯和把腿抬进抬出汽车等活动加剧的疼痛可以作为有用的诊断线索。最常见的撞击部位是髋臼杯,那里与髂腰肌肌腱的深层有摩擦。髂腰肌肌腱位于髋关节前方,仅由髂腰肌滑囊与囊分离。撞击的原因包括骨赘、骨水泥挤压、Rouviere沟、假体前倾不充分、钉或螺钉突出、加固环过大、或髋偏移量增加或髋长度≥1厘米我们描述继发于骨赘的髂腰肌肌腱撞击。髂腰肌肌腱撞击的保守治疗包括超声(US)引导下的麻醉/皮质类固醇注射、活性改变和非甾体抗炎药物,通常在最初进行试验。在保守治疗方案失败后,手术替代方案,如开放或关节镜下腰肌肌腱切断术和翻修髋关节置换术可以可靠地改善患者的症状。然而,开放性手术有较高的感染风险,需要较长的住院时间和恢复期,2关节镜手术也增加了神经血管损伤的风险。US的使用在骨科手术中越来越受欢迎,一些人利用它的优点在髋关节镜中放置门静脉我们建议在美国指导下进行肌腱切开术和截骨术来治疗髋关节髋关节置放术后的腓肠肌撞击,因为它提供了一种侵入性较小的选择,减少了住院时间和恢复时间。技术
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来源期刊
CiteScore
0.60
自引率
0.00%
发文量
31
期刊介绍: The purpose of Techniques in Orthopaedics is to provide information on the latest orthopaedic procedure as they are devised and used by top orthopaedic surgeons. The approach is technique-oriented, covering operations, manipulations, and instruments being developed and applied in such as arthroscopy, arthroplasty, and trauma. Each issue is guest-edited by an expert in the field and devoted to a single topic.
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