Ultrasound-Guided Iliopsoas Bursal Injections for Management of Iliopsoas Bursitis After Total Hip Arthroplasty.

BACKGROUND: Iliopsoas tendonitis can cause persistent pain after total hip arthroplasty (THA). Nonoperative management of iliopsoas tendonitis includes anti-inflammatory drugs and image-guided corticosteroid injections. This study evaluated the efficacy of ultrasound-guided corticosteroid injections (US-CSIs) for iliopsoas tendonitis following THA. METHODS: We retrospectively reviewed 42 patients who received an US-CSI for iliopsoas tendonitis after primary THA between 2009 and 2020 at a single institution. Outcomes including reoperation, groin pain at last follow-up, additional intrabursal injection, and Harris Hip Score (HHS) were evaluated at a minimum of 1 year. Cross-table lateral radiographs (36 patients) or computed tomography scans (6 patients) were reviewed to determine if anterior cup overhang was present, indicating a mechanical etiology of iliopsoas tendonitis. Descriptive statistics and univariate comparison of HHS preinjection and postinjection were performed, with alpha < 0.05. RESULTS: Among the 22 patients who did not have cup overhang, four (18.2%) had persistent groin pain at mean follow-up of 40 months (range, 14-94) after US-CSI. Three patients had a second injection; none had groin pain at most recent follow-up. No patients required acetabular revision. Mean HHS improved from 74 points (range, 52-94 points) to 91 points (range, 76-100 points; P < .001) at last follow-up. Among the 20 patients who had anterior cup overhang, five underwent acetabular revision after only temporary pain relief from injection. Groin pain was resolved in all revised patients at mean follow-up of 43 months (range, 12-60) after revision. Of the remaining 15 patients, five had persistent groin pain at mean follow-up of 35 months (range, 12-83). Mean HHS improved from 69 points (range, 50-96 points) preinjection to 81 (range, 56-98 points; P = .007) at last follow-up. CONCLUSION: Resolution of groin pain was demonstrated in 78.6% of patients in the cohort; however, those who did not have acetabular overhang had higher rates of success. The overall revision rate was 11.9%. US-CSI appears to be safe and effective in the diagnosis and treatment of iliopsoas tendonitis following primary THA. LEVEL OF EVIDENCE: Level IV, Therapeutic Study.

Prevalence of iliopsoas bursitis in patients with end-stage hip osteoarthritis.

OBJECTIVES: Iliopsoas bursitis (IB) is a relatively rare condition that is associated with hip diseases. It can cause neurological symptoms and swelling of the lower extremities by compressing the femoral nerve and vessels. The aim of this study is to examine the prevalence of IB in patients with end-stage hip osteoarthritis. METHODS: A total of 544 patients underwent total hip arthroplasty between May 2010 and May 2019. All patients were examined using computed tomography (CT) to perform preoperative planning. We reviewed the CT images and examined the prevalence and size of IB. These lesions were divided into three types based on their shape (round type, oval type, and heart-shaped type). RESULTS: Of the 544 patients, IB was found in 37 patients. We observed the round type in 4 patients, the oval type in 31 patients, and the heart-shaped type in 2 patients. Two patients showed severe swelling in the legs and had a blood circulatory disorder of the legs. Both cases were heart-shaped bursitis. CONCLUSION: Symptomatic IB was observed in two cases, both of which had a heart shape surrounding the iliopsoas tendon and femoral neurovascular bundle. Although symptomatic IB is a rare condition, special attention is required for heart-shaped IB.

Ultrasound in Total Hip Replacement: Value of Anterior Acetabular Cup Visibility and Contact With the Iliopsoas Tendon.

OBJECTIVES: To assess visibility of the acetabular cup in total hip replacement and to determine the value of direct and indirect signs of iliopsoas impingement syndrome with ultrasound. METHODS: Ultrasound examinations were performed by a single operator in 17 patients with iliopsoas impingement syndrome and 48 control patients. Cup visibility, contact between the cup and psoas tendon, and the presence of indirect signs of iliopsoas impingement syndrome were investigated in all patients. When the acetabular cup was visible, its size and position in relation to the psoas tendon were recorded. RESULTS: Anterior cup visibility (P = .03), contact with the psoas tendon (P < .001), psoas tendinopathy (P = .02), and iliopsoas bursitis (P < .001) were significantly associated with iliopsoas impingement syndrome, the latter reported with specificity of 100%. In the sagittal plane at the level of the psoas tendon, a maximum sagittal length of greater than 5 mm and a posteroanterior cup shift of 3 mm or greater yielded respective sensitivities of 82% and 59% and specificities of 81% and 100%. CONCLUSIONS: When iliopsoas impingement syndrome is clinically suspected, the presence of iliopsoas bursitis or a posteroanterior cup shift of greater than 3 mm under the psoas tendon serve to confirm the diagnosis. In the absence of these conditions, a therapeutic test may be necessary because of the incomplete, albeit high, specificity of other signs.

Treatment of Chronic Degenerative Hip Pain in a Male Patient With Cerebral Palsy Four Decades After Reverse Osteotomy.

Patients with cerebral palsy (CP) frequently require surgical hip interventions in early adulthood due to spasticity-related gait abnormalities. In most instances, these cases are characterized by severe restrictions on mobility. This is the case of a male patient with CP who underwent right proximal femoral open reduction internal fixation (ORIF) and reverse osteotomy for right hip subluxation in young adulthood. Patients with CP who undergo total hip arthroplasty (THA) or ORIF with reverse osteotomy often require future revision. The patient was initially given an estimated 10-year longevity for his plate and screw construct (hardware). Forty-four years later, the patient presented with debilitating chronic bilateral hip pain, requiring the assistance of a cane for ambulation. There is a limited body of knowledge on ORIF and reverse osteotomy follow-up in patients with CP within a 30- to 50-year period. At the 44th-year follow-up, CT and X-ray imaging found postoperative changes in the right femur, including intact hardware, bilateral acetabular dysplasia, right femoral stress fracture, progression of hip arthritis, and right iliopsoas bursitis. Surgery for hardware revision was not indicated. Gradual restoration of function was achieved over a 14-month period with conservative management. This case suggests that physical therapy (PT), exercise, and sporadic non-steroidal anti-inflammatory drug (NSAID) use are effective for improving chronic degenerative changes, associated bursitis, and loss of function in patients who developed CP-induced gait complications in young adulthood. These improvements can be made several decades after undergoing ORIF and osteotomies. This course of treatment was effective in improving the patient's quality of life without additional surgical interventions.

A Case of Iliopsoas Bursitis With Compressive Femoral Nerve Palsy Treated With Iliopsoas Tendon Release.

Iliopsoas bursitis is a well-established cause of groin pain after total hip arthroplasty (THA), and it can become dramatically more complex when associated with neurovascular compression. Iliopsoas bursitis may be caused by a variety of pathologies in the setting of a THA but most frequently due to a prominent acetabular component or implant wear. Here we report a rare case of a female patient presenting with iliopsoas tendonitis, an accompanying femoral nerve palsy, and debilitating pain beginning 12 years after a previously successful primary THA without apparent implant wear. Ultimately, our patient was treated successfully with iliopsoas tendon release for anterior prominence of the acetabular component.

It's Not Always the Appendix: An Unusual Case of Right Lower Quadrant Pain in an Emergency Department Patient Due to Iliopsoas Bursitis From Uncommon Sleep Positioning.

Patients presenting to the emergency department (ED) with right lower quadrant pain will typically have acute appendicitis at the top of a limited differential. We present an unusual case of right lower quadrant pain in a 45-year-old female emergency department patient. She was referred from primary care for evaluation of suspected appendicitis with a final diagnosis of iliopsoas bursitis caused by sleep positioning. Knowledge of the appropriate evaluation and treatment of this unusual ED presentation is important for accurate diagnosis and appropriate referral to avoid unnecessary patient morbidity.

Femoral Nerve Palsy due to Noninfectious Iliopsoas Bursitis and Hematoma after Total Hip Arthroplasty: A Case Report.

Femoral nerve palsy after total hip arthroplasty is an uncommon complication. We present a case report of delayed-onset femoral nerve palsy associated with iliopsoas hematoma and bursitis 10 years after primary total hip arthroplasty in a 57-year-old male patient with avascular necrosis of the femoral head. The patient visited our clinic due to swelling of the inguinal area with sudden-onset knee extension weakness. Radiologic examination at admission revealed suspicion of bursitis and hematoma on iliopsoas muscle. After evacuation of the hematoma and bursitis debridement, the patient's clinical symptoms improved dramatically. This is a rare report of femoral nerve palsy due to noninfectious iliopsoas bursitis and hematoma after total hip arthroplasty.

Synovial cysts of the hip.

BACKGROUND: Synovial cysts of the hip are relatively rare lesions comparing to other joints. Patients are usually asymptomatic, but in some cases symptoms such as pain and/or compression of vessels or nerve could be present. Purpose of the study was to define clinical features and optimal management of synovial cyst of the hip joint through an accurate review of the literature. METHODS: We present three consecutive cases treated with three different therapeutic strategies: surgical excision, wait-and-see and needle aspiration. An accurate review of the literature has been performed to identify patients who had been treated for synovial cyst of the hip. RESULTS: Due to the rarity of the disease, there are no significant data in literature supporting the gold standard of treatment. Treatment of the synovial cyst depends on their size, symptoms and comorbidities. CONCLUSIONS: Most of the Authors recommend surgical treatment for symptomatic synovial cysts and needle aspiration as an option treatment in asymptomatic patients without vessel or nerve compression. In patients that referred symptoms in correspondence with the hip joint, not strictly related with radiograph findings, a CT or MRI examinations should be performed to exclude possible differential diagnosis.

Iliopsoas: Pathology, Diagnosis, and Treatment.

Disorders of the iliopsoas can be a significant source of groin pain in the athletic population. Commonly described pathologic conditions include iliopsoas bursitis, tendonitis, impingement, and snapping. The first-line treatment for iliopsoas disorders is typically conservative, including activity modification, physical therapy, nonsteroidal anti-inflammatory drugs, and corticosteroid injections. Surgical treatment can be considered if the patient fails conservative measures and typically involves arthroscopic lengthening of the musculotendinous unit and treatment of concomitant intra-articular abnormality. Tendon release has been described: in the central compartment, in the peripheral compartment, and at the lesser trochanter, with similar outcomes observed between the techniques.

Abductor muscle necrosis due to iliopsoas bursal mass after total hip arthroplasty.

BACKGROUND: While symptomatic iliopsoas bursal lesions have been reported after total hip arthroplasty (THA), mass effect of the collection causing abductor muscle damage has not been reported in the literature. METHODS AND RESULTS: This report discusses the presentation, clinical findings, and operative management of a patient, status post metal-on-polyethylene THA, with a large psoas bursal collection with resulting abductor muscle injury and deep venous thrombosis from compression of the femoral vein. Despite the improved wear characteristics of modern-generation THA implants, physicians must be aware of the possibility of soft tissue irritation of the iliopsoas as a cause of soft tissue swelling, persistent pain, and potential adverse complications. It is also important to recognize the variety of effects and spectrum of severity for associated lesions, including muscle damage. CONCLUSIONS: This report highlights the rare findings of abductor muscle necrosis, as well as acute thrombosis, related to iliopsoas bursitis. It also highlights a review of the available literature.

A Rare Case of Femoral Neuropathy Associated with Ilio-Psoas Bursitis After 10 Years of Total Hip Arthroplasty.

We describe a case of femoral nerve palsy caused due to non-infective large iliopsoas bursitis after 10 years of cementless ceramic-on-metal THA. Bursectomy and exploration of femoral nerve were done to relieve the compressive symptoms of femoral nerve. Patient neurological symptoms were recovered within six months. Iliopsoas bursitis after THA can lead to anterior hip pain, lump in inguinal area or abdomen, limb swelling due to venous compression or more rarely neurovascular compressive symptoms depending on size and extension. Treating physician should be aware of this rare condition after THA in the absence of any radiographic findings so that prompt diagnosis and treatment can be carried out.

Groin pain and iliopsoas bursitis: always a cause-effect relationship?

BACKGROUND AND OBJECTIVE: Iliopsoas bursitis (IB) is characterized by inflammation and enlargement of the iliopsoas bursa. Although this condition is often associated with degenerative or inflammatory arthritis, infections, trauma, overuse and impingement syndromes, osteonecrosis and hip replacement, the pathogenesis of IB remains uncertain. We present a case report of IB associated with moderate hip osteoarthritis (HOA). METHODS: We present a case report of a 73-year-old man with chronic left hip pain that did not respond to conservative treatments. An ultrasonography examination of the left hip revealed fluid-induced distension of the iliopsoas bursa, which was treated with aspiration followed by a corticosteroid-anesthetic injection. RESULTS: At the 30-day follow-up, despite an initial improvement in the patient's symptoms, both the pain and functional limitation returned, though not in association with bursa distension. The patient therefore underwent a total hip arthroplasty, which fully relieved the symptoms. CONCLUSION: We hypothesize that iliopsoas bursitis may, when associated with other pathological conditions, not be the only source of pain. It should, nevertheless, be considered for differential diagnosis purposes.

An atypical case of noninfected iliopsoas bursitis - MRI findings.

The authors present an unusual case of atypical iliopsoas bursitis in an 81 years-old female patient. The patient asked for medical advice due to a chronic left hip and lower abdominal pain with no specific characteristics. Physical examination revealed a palpable left-sided pelvic mass. Ultrasound examination demonstrated a purely cystic mass that was presumed to be an ovarian cystic malignancy. The patient was referred for an MRI examination, which showed a cystic lesion extending from the left iliac crest to the anterior aspect of the ipsilateral hip joint (maximum diameter 18 cm), coursing below the iliopsoas tendon indicative of an extremely distended iliopsoas bursa.