Arthroscopic Versus Open Iliopsoas Release After Total Hip Arthroplasty

Q3 Medicine

Arthroscopy Sports Medicine and Rehabilitation Pub Date : 2025-08-01 DOI:10.1016/j.asmr.2025.101190

Charles L. Holliday M.D., Karissa N. Simon B.S., Robert T. Trousdale M.D., Michael J. Taunton M.D., Bruce A. Levy M.D., Mario Hevesi M.D., Ph.D.

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Abstract

Purpose

To evaluate the differences in clinical outcomes and complication rates between open and arthroscopic iliopsoas (IP) tenotomy between 1998 and 2023 at our institution.

Methods

Patients who underwent arthroscopic iliopsoas fractional lengthening (IPFL) or open tenotomy for IP tendinitis following total hip arthroplasty (THA) between 1988 and 2023 were identified. Patients were excluded if they underwent revision IP tendon release, had additional concomitant procedures, or had less than a 24-month postoperative follow-up. Patient records were reviewed, and patient-reported outcomes were collected via electronic survey.

Results

Fifty-two patients (36 arthroscopic, 16 open) were followed for an average of 68.7 (24.0-203.7) months. Overall surgery satisfaction was 7.9 (scale 0-10) following arthroscopic IPFL and 6.0 following open tenotomy (P = .178). Eighty-six percent of patients reported improvement in their anterior groin pain following arthroscopic IPFL, compared to 45% following open tenotomy (P = .065). In the arthroscopic cohort, 64% reported improved hip flexion strength, compared to 36% in the open cohort (P = .158). Visual analog scale for pain at rest was lower following arthroscopic IPFL (1.1 ± 2.2 vs 3.3 ± 3.2, P = .0092), while pain with use did not differ between cohorts (3.1 ± 1.3 vs 2.6 ± 1.1, P = .786). There were no differences in postoperative Tegner (3.1 ± 1.3 vs 2.6 ± 1.1, P = .302), modified Harris Hip Score (77.0 ± 19.0 vs 69.2 ± 26.9, P = .073), or Single Assessment Numeric Evaluation (70.9 ± 28.7 vs 66.7 ± 31.8, P = .571) scores between arthroscopic and open cohorts. Revision THA rates did not differ following arthroscopic or open procedures (8.3% vs 25%, P = .104).

Conclusions

Patients have improved pain at rest following arthroscopic IPFL when compared to open tenotomy for IP tendinitis following THA. Overall complication and reoperation rates were low for both techniques.

Level of Evidence

Level III, retrospective cohort study.

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全髋关节置换术后关节镜与开放式髂腰肌松解

目的评价1998年至2023年我院开放髂腰肌（IP）肌腱切断术与关节镜下髂腰肌（IP）肌腱切断术的临床疗效和并发症发生率的差异。方法对1988年至2023年间在全髋关节置换术（THA）后接受关节镜髂腰肌分数延长（IPFL）或开放式肌腱切开术治疗IP腱炎的患者进行分析。如果患者接受了改良的IP肌腱释放，有额外的伴随手术，或术后随访时间少于24个月，则排除。回顾患者记录，并通过电子调查收集患者报告的结果。结果52例患者（36例关节镜下手术，16例切开手术）平均随访68.7（24.0 ~ 203.7）个月。关节镜下IPFL术后总体手术满意度为7.9分（评分0-10分），开放肌腱切开术术后总体手术满意度为6.0分（P = 0.178）。86%的患者报告关节镜下IPFL后腹股沟前疼痛得到改善，而开放肌腱切开术后为45% （P = 0.065）。在关节镜组中，64%的患者报告髋屈曲强度得到改善，而在开放组中，这一比例为36% （P = 0.158）。关节镜下IPFL术后休息时疼痛的视觉模拟量表较低（1.1±2.2 vs 3.3±3.2,P = 0.0092），而使用时疼痛在队列间无差异（3.1±1.3 vs 2.6±1.1,P = .786）。术后Tegner（3.1±1.3 vs 2.6±1.1,P = .302）、改良Harris髋关节评分（77.0±19.0 vs 69.2±26.9,P = .073）或单一评估数值评估（70.9±28.7 vs 66.7±31.8,P = .571）评分在关节镜组和开放组之间无差异。关节镜或开放手术后翻修THA率无差异（8.3% vs 25%, P = 0.104）。结论：与开放性肌腱切开术治疗THA后IP腱炎相比，关节镜下IPFL术后患者休息时疼痛有所改善。两种技术的并发症和再手术率均较低。证据水平：III级，回顾性队列研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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