Outcomes of Nonoperative versus Operative Treatment of Iliopsoas Impingement after Total Hip Arthroplasty: A Systematic Review and Meta-Analysis.

Background: Iliopsoas impingement (IPI) is a rare cause of persistent groin pain after primary total hip arthroplasty (THA). Treatment options include conservative management such as corticosteroid injections into the tendon sheath, iliopsoas tenotomy, and acetabular revision. The purpose of this systematic review is to compare outcomes of nonoperative versus operative treatment options for IPI after THA by assessing symptom resolution rate, patient-reported outcomes, complications, and revision surgery rate.

Methods: A systematic review following guidelines established by the Preferred Reporting Items for Systematic Reviews and Meta-analyses was performed in the PubMed, Embase, and Cochrane Library databases regarding IPI after THA. Studies were categorized based on the specific treatment modality: conservative treatment (corticosteroid injections), iliopsoas tenotomy, or acetabular revision. There were six studies (151 patients) that evaluated conservative treatment, 21 studies (452 patients) that evaluated iliopsoas tenotomy, and five studies (103 patients) that evaluated acetabular revision as treatment options for IPI after THA.

Results: The mean preoperative to postoperative Harris Hip Scores for the three groups were 64.8 to 78.6 (P = 0.03), 54.9 to 83.1 (P < 0.00001), and 56 to 82.4 (P < 0.00001), respectively. Persistent IPI symptoms were noted in 53.6% (conservative), 17.8% (iliopsoas tenotomy), and 12.6% (acetabular revision) of patients. The complication rate for surgical treatment was 2.3% in the iliopsoas tenotomy group and 15.7% in the acetabular revision group. Revision surgery or additional surgical intervention was required by 16.4% (conservative), 4.5% (iliopsoas tenotomy), and 3.9% (acetabular revision) of patients.

Conclusions: Nonoperative management of IPI after THA may fail to provide long-term resolution of symptoms. While iliopsoas tenotomy and acetabular revision both effectively treat IPI after THA, tenotomy has a significantly lower complication rate compared to acetabular revision. Thorough patient counseling is critical when discussing surgical treatment options for persistent symptomatic IPI after THA.

Level Of Evidence: IV.