Significant Clinical Improvements Following Arthroscopic Iliopsoas Fractional Lengthening After Total Hip Arthroplasty: A Prospective Multicenter Study.

Abstract

Purpose: To prospectively investigate subjective anterior groin pain, patient-reported outcome measures, complications, reoperation rates, and hip flexion strength after arthroscopic iliopsoas fractional lengthening.

Methods: From 2023 to 2025, patients with persistent groin pain after total hip arthroplasty refractory to conservative management undergoing arthroscopic iliopsoas fractional lengthening were prospectively identified at 2 tertiary referral centers. Pre- and postoperative outcomes at a minimum 6-month follow-up including the Visual Analog Scale, Tegner activity scale, Single Assessment Numeric Evaluation, and subjective anterior groin pain and hip flexion strength were analyzed.

Results: Fifty-nine hips in 56 patients were included (age: 64.9 ± 9.8 years, 59% women, body mass index: 30.0 ± 5.8 kg/m²) and followed for 10.0 ± 6.9 months postoperatively (range: 4-25 months). Patients experienced significant (P < .001) postoperative improvements in the Visual Analog Scale at rest (1.4 ± 2.2 vs 2.8 ± 2.1), Visual Analog Scale with use (3.0 ± 2.9 vs 7.8 ± 1.8), Tegner activity scale (2.8 ± 1.2 vs 2.0 ± 1.0), and Single Assessment Numeric Evaluation score (73.8 ± 22.5 vs 47.7 ± 22.2). Postoperative surgical satisfaction was 8.0 ± 2.7 (scale: 0-10). Nearly 90% of patients reported feeling much or slightly better regarding their anterior groin pain postoperatively at 2-week (91%), 6-week (88%), 3-month (91%), and final follow-up (92%). Regarding hip flexion strength, ≥66% reported feeling much or slightly better at 2-week (73%), 6-week (95%), 3-month (89%), and final follow-up (66%). Three hips (6%) underwent reoperation at the final follow-up (1 acetabular screw removal with open revision release, 1 revision total hip arthroplasty for loosening, and 1 two-stage exchange for nonacute periprosthetic joint infection).

Conclusions: Nearly 90% of patients who underwent arthroscopic iliopsoas fractional lengthening after primary total hip arthroplasty reported improved anterior groin pain, whereas two-thirds reported increased subjective hip flexion strength throughout the follow-up. Of note, clinically meaningful improvement in pain at rest was achieved by 50% of patients based on cohort-specific minimal clinically important difference criteria.

Level of evidence: Level IV, retrospective therapeutic case series.