Chalmers, Brian P.

Background: A potential cause of persistent groin pain after total hip arthroplasty is impingement of the iliopsoas tendon. Treatment options include conservative management, tenotomy, and acetabular revision, but the literature, to our knowledge, has been limited to small case series on each technique. We present a series of patients with iliopsoas impingement after total hip arthroplasty and evaluate efficacy and risk factors for success or failure of each treatment strategy. Methods: Forty-nine patients treated at one institution for a diagnosis of iliopsoas impingement after primary total hip arthroplasty with hemispherical acetabular component and polyethylene bearing were retrospectively reviewed. Twenty-one patients underwent acetabular revision, 8 patients underwent tenotomy, and 20 patients had nonoperative management. The mean follow-up was 4 years. Anterior acetabular component prominence was measured on true lateral hip radiographs. Results: At the most recent follow-up, 10 patients (50%) in the nonoperative group had groin pain resolution compared with 22 patients (76%) in the operative group (p = 0.06). In patients with <8 mm of component prominence, tenotomy provided resolution of groin pain in 5 (100%) of 5 patients and a mean Harris hip score of 89 points. In patients with ≥8 mm of prominence, acetabular revision led to groin pain resolution in 12 (92%) of 13 patients compared with 1 (33%) of 3 patients treated with tenotomy (p = 0.07). Conclusions: Nonoperative management of iliopsoas impingement led to groin pain resolution in 50% of patients. In patients with minimal acetabular component prominence, iliopsoas release provided a high rate of success. Acetabular revision was more predictable for groin pain resolution in patients with ≥8 mm of anterior component prominence. Level of Evidence: Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.

Background Dislocation is a challenging complication after reverse shoulder arthroplasty (RSA). We sought to evaluate the outcome of nonoperative and operative management of the dislocation after primary and revision RSA. Methods Between 2006 and 2013, dislocation occurred in 12/1081 primary RSAs (1.1%) and 15/342 revision RSAs (4.4%). Seventeen (69%) shoulders dislocated within 3 months of surgery. Ten (68%) patients underwent revision RSA for prosthetic instability. Mean age was 69 years, and mean follow-up after index RSA was 4 years. Results Closed reduction and bracing achieved a stable shoulder in 60% (3/5 patients) after primary and 20% (1/5 patients) after revision RSA dislocation. Operative management achieved a stable shoulder in 88% (7/8 patients) of primary and 64% (7/11 patients) of revision RSAs ( P = .40). Overall, 9 shoulders (33%) had persistent instability at the final follow-up: 2/12 (17%) primaries versus 7/15 (47%) revisions ( P = .08). Preoperative prosthetic instability was the main risk factor for chronic instability in the revision cohort ( P = .02). Worse functional outcomes were associated with the dislocation of a revision RSA ( P = .02). Conclusion After primary RSA dislocations, closed reduction is successful in half, while revision surgery is successful in 85% of cases. Conversely, closed reduction of a dislocated revision RSA is rarely successful, while revision surgery is successful 65% of the time. Every attempt should be made to achieve stability at the time of primary and revision RSA, since reduction or revision surgery does not guarantee the restoring stability.