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Rieger C, Pfister D, Kastner L, Eich ML, Quaas A, Tolkach Y, Heidenreich A. Cystic Pelvic Masses in Men: A Presentation of Uncommon Cases and a Literature Review. Clin Genitourin Cancer 2024; 22:523-534. [PMID: 38281876 DOI: 10.1016/j.clgc.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 01/07/2024] [Accepted: 01/07/2024] [Indexed: 01/30/2024]
Abstract
Unclear cystic masses in the pelvis in male patients are a rare situation and could be of benign or malignant origin. The underlying diseases demand for specific diagnostic and therapeutic approaches. We present a case series of 3 male patients with different clinical symptoms (perineal pain, urinary retention and a large scrotal cyst) related to cystic lesions in the pelvic region. On all patients initial histopathological workup was unclear. All patients underwent surgery with complete resection of the tumor which revealed a broad spectrum of histopathological findings: unusual form of cystic adenocarcinoma of the prostate, malignant transformation of a dysontogenetic cyst, and finally a very rare diagnosis of a malignant tumor of the Cowper gland. This case series and literature review provide clues for a possible diagnostic and therapeutic approach in the case of unclear pelvic cystic masses and could support urologists during the therapy selection in the future.
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Affiliation(s)
- Constantin Rieger
- Department of Urology, Uro-Oncology, Robot-Assisted and Specialized Urologic Surgery, University Hospital Cologne, Cologne, Germany.
| | - David Pfister
- Department of Urology, Uro-Oncology, Robot-Assisted and Specialized Urologic Surgery, University Hospital Cologne, Cologne, Germany
| | - Lucas Kastner
- Department of Urology, Uro-Oncology, Robot-Assisted and Specialized Urologic Surgery, University Hospital Cologne, Cologne, Germany
| | - Marie-Lisa Eich
- Institute of Pathology, University Hospital Cologne, Cologne, Germany
| | - Alexander Quaas
- Institute of Pathology, University Hospital Cologne, Cologne, Germany
| | - Yuri Tolkach
- Institute of Pathology, University Hospital Cologne, Cologne, Germany
| | - Axel Heidenreich
- Department of Urology, Uro-Oncology, Robot-Assisted and Specialized Urologic Surgery, University Hospital Cologne, Cologne, Germany
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Conroy J, Caus S, Nelms NJ. A Case of Iliopsoas Bursitis With Compressive Femoral Nerve Palsy Treated With Iliopsoas Tendon Release. Arthroplast Today 2022; 14:148-153. [PMID: 35313716 PMCID: PMC8933726 DOI: 10.1016/j.artd.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 02/12/2022] [Accepted: 02/13/2022] [Indexed: 11/28/2022] Open
Abstract
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.
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Minimum 5-year follow-up of arthroscopic treatment of symptomatic iliopectineal cyst. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 31:1369-1374. [PMID: 33528642 DOI: 10.1007/s00590-021-02877-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 01/12/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION We aimed to primarily assess the clinical and functional outcomes of arthroscopic treatment of the symptomatic iliopectineal cyst at a minimum 5-year follow-up. Our secondary objective was to document the technical nuances of our arthroscopic technique. METHODS A retrospective review of chart data was performed for 30 patients who underwent arthroscopic treatment of a symptomatic iliopectineal cyst in the period between 1999 and 2015. The mean age of our patients was 57 (33-78) years. All patients completed a minimum follow-up period of 5 years. Our clinical outcomes were assessed by 100 mm VAS for pain, recurrence rate and complications. Functional outcome was evaluated by the modified Harris hip score (mHHS). Patients were asked their level of satisfaction with surgery on a scale of 0-10. RESULTS In all patients, the valve mechanism of the iliopectineal cyst could be released arthroscopically and the cyst could be completely evacuated. The preoperative symptoms disappeared within 3-6 weeks after the arthroscopic intervention. Patients showed significant improvement in VAS and mHHS 6 months postoperatively and at final follow-up. The average patient satisfaction was 9.2 at 6 months postoperative and 7.9 at final follow-up. None of our patients experienced any complications. At the final follow-up, there was neither clinical nor radiological evidence of cyst recurrence. CONCLUSIONS Arthroscopic treatment of the iliopectineal cyst is a feasible and safe alternative to open surgery resulting in significant improvement of clinical and functional outcomes.
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Diaz-Ledezma C, Espinosa-Mendoza R, Gallo J, Glaudemans A, Gómez-García F, Goodman S, Kaminek M, Le Roux TLB, Llinás A, Nieslanikova E, Quinn L, Sculco P, Svoboda M. General Assembly, Diagnosis, Imaging: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34:S215-S223. [PMID: 30360979 DOI: 10.1016/j.arth.2018.09.073] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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Gandhi J, Zaidi S, Suh Y, Joshi G, Smith NL, Ali Khan S. An index of inguinal and inguinofemoral masses in women: Critical considerations for diagnosis. TRANSLATIONAL RESEARCH IN ANATOMY 2018. [DOI: 10.1016/j.tria.2018.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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The role of arthroscopy in the treatment of groin pain after total hip arthroplasty: our experience. Hip Int 2016; 26 Suppl 1:28-33. [PMID: 27174071 DOI: 10.5301/hipint.5000405] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/22/2016] [Indexed: 02/04/2023]
Abstract
AIM The purpose of the study was to present our arthroscopic surgical technique and the results in patient with pain after a hip replacement. METHODS Between November 2009 and September 2011, 35 patients with groin pain after total hip arthroplasty (THA) were treated arthroscopically. The patients underwent a preoperative examination consisting in careful history, physical examination, laboratory evaluation, diagnostic evaluation using x-rays and pelvis CT scans. In patients for whom the clinical picture suggested iliopsoas tendonitis, we also performed injection of local anaesthetic on the iliopsoas tendon sheath. All the patients were positioned in the supine decubitus position with traction applied, using 2 arthroscopic portals (AL, MID-A). An extensive debridement of adhesions, periprosthetic tissue and neocapsula were performed; when there were signs of iliopsoas impingement, a transcapsular tenotomy was performed according to Wettstein technique. RESULTS The average age was 57 (29-77) years old. The average time to onset of symptoms was 10.8 (5-15) months after THA. The average preoperative Harris Hip Score (HHS) was 44.1 (range 32-56). The average preoperative Medical Research Council (MRC) scale for muscle strenght was 3.27 (range 3-4). After 24 months of follow-up patients show an average HHS of 75.73 (range 50-91). Patients who underwent iliopsoas release show a postoperative HHS of 83.28 (range 61-91). The average postoperative MRC scale was 4.45. CONCLUSIONS Hip arthroscopy in treatment of reactive synovitis and adhesions shows good results according to literature. Hip arthroscopy in treatment of anterior iliopsoas impingement is the most useful instrument, being less invasive than the classic open technique.
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DeFrancesco CJ, Kamath AF. Abductor muscle necrosis due to iliopsoas bursal mass after total hip arthroplasty. J Clin Orthop Trauma 2015; 6:288-92. [PMID: 26566347 PMCID: PMC4600845 DOI: 10.1016/j.jcot.2015.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2014] [Accepted: 05/04/2015] [Indexed: 11/28/2022] Open
Abstract
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.
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Affiliation(s)
| | - Atul F. Kamath
- Assistant Professor of Orthopaedic Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA,Corresponding author at: Department of Orthopaedic Surgery, University of Pennsylvania, Pennsylvania Hospital, 8th Floor Preston, Philadelphia, PA 19107, USA. Tel.: +1 215 687 8169; fax: +1 215 829 2492.
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Yukata K, Nakai S, Goto T, Ikeda Y, Shimaoka Y, Yamanaka I, Sairyo K, Hamawaki JI. Cystic lesion around the hip joint. World J Orthop 2015; 6:688-704. [PMID: 26495246 PMCID: PMC4610911 DOI: 10.5312/wjo.v6.i9.688] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 07/13/2015] [Accepted: 09/08/2015] [Indexed: 02/06/2023] Open
Abstract
This article presents a narrative review of cystic lesions around the hip and primarily consists of 5 sections: Radiological examination, prevalence, pathogenesis, symptoms, and treatment. Cystic lesions around the hip are usually asymptomatic but may be observed incidentally on imaging examinations, such as computed tomography and magnetic resonance imaging. Some cysts may enlarge because of various pathological factors, such as trauma, osteoarthritis, rheumatoid arthritis, or total hip arthroplasty (THA), and may become symptomatic because of compression of surrounding structures, including the femoral, obturator, or sciatic nerves, external iliac or common femoral artery, femoral or external iliac vein, sigmoid colon, cecum, small bowel, ureters, and bladder. Treatment for symptomatic cystic lesions around the hip joint includes rest, nonsteroidal anti-inflammatory drug administration, needle aspiration, and surgical excision. Furthermore, when these cysts are associated with osteoarthritis, rheumatoid arthritis, and THA, primary or revision THA surgery will be necessary concurrent with cyst excision. Knowledge of the characteristic clinical appearance of cystic masses around the hip will be useful for determining specific diagnoses and treatments.
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Singh V, Shon WY, Lakhotia D, Kim JH, Kim TW. A Rare Case of Femoral Neuropathy Associated with Ilio-Psoas Bursitis After 10 Years of Total Hip Arthroplasty. Open Orthop J 2015; 9:270-3. [PMID: 26312109 PMCID: PMC4541316 DOI: 10.2174/1874325001509010270] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Revised: 04/19/2015] [Accepted: 05/18/2015] [Indexed: 11/26/2022] Open
Abstract
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.
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Affiliation(s)
- Vivek Singh
- Department of Orthopaedic Surgery, Korea University College of Medicine, Guro Hospital, 97 Gurodong-gil, Guro-gu, Seoul, 152-703, Korea
| | - Won Yong Shon
- Department of Orthopaedic Surgery, Korea University College of Medicine, Guro Hospital, 97 Gurodong-gil, Guro-gu, Seoul, 152-703, Korea
| | - Devendra Lakhotia
- Department of Orthopaedic Surgery, Korea University College of Medicine, Guro Hospital, 97 Gurodong-gil, Guro-gu, Seoul, 152-703, Korea
| | - Jong Hoon Kim
- Department of Orthopaedic Surgery, Korea University College of Medicine, Guro Hospital, 97 Gurodong-gil, Guro-gu, Seoul, 152-703, Korea
| | - Tae Wan Kim
- Department of Orthopaedic Surgery, Korea University College of Medicine, Guro Hospital, 97 Gurodong-gil, Guro-gu, Seoul, 152-703, Korea
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Algarni AD, Huk OL, Pelmus M. Metallosis-induced iliopsoas bursal cyst causing venous obstruction and lower-limb swelling after metal-on-metal THA. Orthopedics 2012; 35:e1811-4. [PMID: 23218642 DOI: 10.3928/01477447-20121120-30] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The formation of iliopsoas bursal cystic lesions after total hip arthroplasty is an infrequently reported condition. This article describes an unusual complication of a current-generation metal-on-metal total hip arthroplasty.A woman presented with unilateral spontaneous lower-limb swelling that developed 5 years postoperatively. It occurred secondary to venous obstruction by a metallosis-induced iliopsoas bursal cyst associated with markedly elevated intralesional cobalt and chromium levels. Metal artifact reduction sequence magnetic resonance imaging showed that the bursal cyst was communicating with the hip joint and that it severely compressed the common femoral vein. Based on the findings of high local tissue metal ions and vertical cup positioning causing edge loading, the authors proposed an inflammatory reaction to metal debris that tracked into the iliopsoas bursa and formed a cyst. The patient underwent revision of the excessively vertical acetabular component and conversion to a ceramic-on-ceramic bearing interface, drainage of the bursal cyst, and synovectomy. No signs existed of local recurrence at 1-year follow-up.To the authors' knowledge, the occurrence of metallosis-induced iliopsoas bursitis with secondary pressure effects after contemporary metal-on-metal total hip arthroplasty has not been reported. When treating hip dysplasia, one must avoid maximizing cup-host bone contact at the risk of oververticalization. Iliopsoas bursal cystic lesions can lead to severe vascular compressive symptoms with no ominous radiographic findings. Physicians and orthopedic surgeons should be aware of the possibility of this complication in patients with unexplained unilateral lower-limb swelling.
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Affiliation(s)
- Abdulrahman D Algarni
- Arthroplasty Division, Department of Orthopedic Surgery, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
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Friedman T, Miller TT. MR imaging and ultrasound correlation of hip pathologic conditions. Magn Reson Imaging Clin N Am 2012; 21:183-94. [PMID: 23168191 DOI: 10.1016/j.mric.2012.09.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Magnetic resonance (MR) imaging has become the workhorse in the imaging evaluation of the painful or clinically abnormal hip. It provides an excellent anatomic overview and demonstration of the bony structures, articular surfaces, and surrounding soft tissues. Conversely, sonography can also demonstrate superficial intraarticular structures and the periarticular soft tissues, is quickly performed, allows dynamic evaluation of tendons and muscles, and can guide percutaneous procedures. These two modalities are complementary, and this article concentrates on the MR imaging-sonographic correlations of several entities about the hip.
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Affiliation(s)
- Talia Friedman
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY 10021, USA
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Douis H, Dunlop DJ, Pearson AM, O'Hara JN, James SLJ. The role of ultrasound in the assessment of post-operative complications following hip arthroplasty. Skeletal Radiol 2012; 41:1035-46. [PMID: 22426776 DOI: 10.1007/s00256-012-1390-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Revised: 01/09/2012] [Accepted: 02/26/2012] [Indexed: 02/02/2023]
Abstract
Hip arthroplasty is one of the most commonly performed orthopedic procedures. Clinicians can be faced with the diagnostic dilemma of the patient presenting with a painful hip following arthroplasty and satisfactory post-operative radiographs. Identifying the cause of symptoms can be challenging and ultrasound is increasingly being utilized in the evaluation of potential soft tissue complications following hip surgery. In this article, we describe the common surgical approaches used during hip arthroplasty as this can influence the nature and location of subsequent complications. A review of the literature is presented along with the imaging appearances frequently encountered when imaging this patient population.
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Affiliation(s)
- H Douis
- Department of Radiology, The Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Northfield, Birmingham, B31 2AP, UK
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Santamato A, Ranieri M, Panza F, Solfrizzi V, Frisardi V, Lapenna LM, Moretti B, Fiore P. Botulinum toxin type A in the treatment of painful adductor muscle contracture after total hip arthroplasty. Orthopedics 2009; 32:orthopedics.43784. [PMID: 19824593 DOI: 10.3928/01477447-20090818-29] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Painful adductor muscle contracture is an important cause of failure during rehabilitation following total hip arthroplasty (THA). Adductor muscle contracture may be caused by postoperative muscle retractions, adhesive capsulitis, postoperative leg-length inequalities caused by implant failure, or preexisting hip pathologies. A 34-year-old woman experienced a persistent painful contracture into the left adductor magnus muscle after THA. She had no leg-length inequalities and, according to the Medical Research Council scale (grades 0-5), muscle strength of the quadriceps was 5/5 for the right side and 3/5 for the left. The degree of functionality according to the Harris hip score (HHS) was 16/100 in the left hip. The pain level, measured with the visual analog scale (VAS), was 7/10. The patient was unable to fully adhere to the rehabilitation program and walked with a limp during the stance phase of gait. After 7 days of treatment with injections of botulinum toxin type A into the left adductor magnus muscle (dose, 150 UM) and subsequent rehabilitation, a great reduction of painful contracture was observed (VAS score, 2/10). The procedure was well tolerated and no adverse effects were noted. After 20 days, hip articular range of motion and gait had improved (HHS score, 75/100). The clinical effects of botulinum toxin type A were present at 2-month follow-up. This treatment may be a viable alternative for the management of painful adductor muscle contracture after THA, without significant side effects.
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Affiliation(s)
- Andrea Santamato
- Department of Physical Medicine and Rehabilitation, University of Foggia, OORR, 71100 Foggia, Italy
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Park KS, Diwanji SR, Kim HK, Song EK, Yoon TR. Hemorrhagic iliopsoas bursitis complicating well-functioning ceramic-on-ceramic total hip arthroplasty. J Arthroplasty 2009; 24:826.e1-5. [PMID: 18701239 DOI: 10.1016/j.arth.2008.06.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2007] [Accepted: 06/09/2008] [Indexed: 02/01/2023] Open
Abstract
Iliopsoas bursitis has been increasingly recognized as a complication of total hip arthroplasty and is usually associated with polyethylene wear. Here, the authors report a case of hemorrhagic iliopsoas bursitis complicating an otherwise well-functioning ceramic-on-ceramic arthroplasty performed by minimal invasive modified 2-incision technique. The bursitis in turn resulted in femoral nerve palsy and femoral vein compression. In this report, there was no evidence to support that the bursitis was due to an inflammatory response to ceramic wear particles or any other wear particles originating from the total hip arthroplasty.
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Affiliation(s)
- Kyung Soon Park
- Center for Joint Disease, Chonnam National University Hwasun Hospital, Ilsim-Ri, Hwasun-Eup, Hwasun-Gun, Jeonnam 519-809, South Korea
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Abstract
Anterior iliopsoas impingement and tendinitis is a poorly understood and likely underrecognized cause of groin pain and functional disability after total hip arthroplasty. The patient history and physical examination findings are usually only suggestive, and the symptoms frequently subtle. The diagnosis may be confirmed by one or more imaging studies, including a cross-table lateral radiograph, computed tomography, magnetic resonance imaging, and ultrasonography, in combination with a confirmatory diagnostic injection. Nonsurgical management may not resolve the problem. Surgical treatment, consisting of release or resection of the iliopsoas tendon, alone or in combination with acetabular revision for an anterior overhanging component, usually provides permanent pain relief.
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Lorenzo LD, Jennifer Y, Pappagallo M. Psoas impingement syndrome in hip osteoarthritis. Joint Bone Spine 2009; 76:98-100. [DOI: 10.1016/j.jbspin.2008.04.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2007] [Accepted: 04/23/2008] [Indexed: 11/26/2022]
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Vandenbussche E, Saffarini M, Delogé N, Moctezuma JL, Nogler M. Hemispheric cups do not reproduce acetabular rim morphology. Acta Orthop 2007; 78:327-32. [PMID: 17611844 DOI: 10.1080/174536707100013870] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Iliopsoas impingement is a recurrent complication following THA, caused by muscle friction against a protrusive prosthetic cup.This study was designed to quantify the dimensional variations in acetabular rim profiles, with particular regard to the iliopubic valley, in order to suggest means to prevent iliopsoas impingement. MATERIAL AND METHODS 34 cadaver pelvises were analyzed using a hip navigation system. The morphometric data were processed to plot profiles of all acetabular rims with particular regard to the shape and depth of the psoas valley. RESULTS The acetabular rim is an asymmetric succession of 3 peaks and 3 troughs. The psoas valley is a salient feature in most pelvises and there is only a weak correlation between its depth (mean 3.8 mm, SD 2.0) and acetabular diameter, anteversion, or inclination. INTERPRETATION It would be difficult to obviate the anterior overlap of the acetabulum using a hemispheric cup, a fortiori in certain morphotypes, without compromising range of motion or risk of dislocation. The solution for prevention of iliopsoas impingement would be to adapt cup design to acetabular anatomy, which may require different implants for the right and left sides, and hence a doubled inventory.
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Affiliation(s)
- Eric Vandenbussche
- Department of Orthopaedic Surgery, Hôpital Européen Georges Pompidou, 20 Rue Leblanc, FR-75908 Paris, France.
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Beksaç B, Tözün R, Baktiroglu S, Sener N, Gonzalez Della Valle A. Extravascular compression of the femoral vein due to wear debris-induced iliopsoas bursitis: a rare cause of leg swelling after total hip arthroplasty. J Arthroplasty 2007; 22:453-6. [PMID: 17400103 DOI: 10.1016/j.arth.2006.04.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2005] [Accepted: 04/05/2006] [Indexed: 02/01/2023] Open
Abstract
We present a patient with unilateral, spontaneous, late leg swelling that developed 4 years after total hip arthroplasty. The etiology was the compression of the internal iliac vein by a voluminous iliopsoas bursitis caused by polyethylene debris. The expansive lesion was detected by ultrasound, arthrography, and magnetic resonance imaging. An ultrasound-guided aspiration provided transient relief of the patient's symptoms. The patient later required surgical excision through an abdominal approach. A second recurrence was detected and treated with revision surgery. We present the diagnosis and the treatment of this rare cause of late, unilateral leg swelling after total hip arthroplasty together with a review of the literature.
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Affiliation(s)
- Burak Beksaç
- Hip and Knee Service, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, New York, USA
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Shabshin N, Rosenberg ZS, Cavalcanti CFA. MR Imaging of Iliopsoas Musculotendinous Injuries. Magn Reson Imaging Clin N Am 2005; 13:705-16. [PMID: 16275578 DOI: 10.1016/j.mric.2005.08.010] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The literature describing iliopsoas compartment injuries is based on case reports and small patient series, mostly in the orthopedic literature.Nevertheless, in recent years, there has been a growing recognition of these injuries. Because many intra-articular and extra-articular bony and soft tissue injuries in the groin may clinically mimic each other, because two or more pathologic entities may coexist, and because athletes are highly motivated to continue with their physical activity, diagnosis of iliopsoas injury is often delayed. Thus, cross-sectional imaging is highly important. MR imaging is most accurate for diagnosing nondynamic diseases of the iliopsoas compartment as well as for ruling out other abnormalities of the hip joint and surrounding structures. When a snapping hip is being investigated or corticosteroid injection is warranted, US can be of help in providing a dynamic study and by guiding the injection.
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Affiliation(s)
- Nogah Shabshin
- Department of Diagnostic Imaging, Chaim Sheba Medical Center, Tel-Hashomer, Israel 52561.
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