Persistent groin pain after hip replacement

The problems of persistent groin pain after Total Hip Arthroplasties (replacement) is a growing concern.  Doctors in Germany revealed troubling complication rates:

• The prevalence of groin pain after conventional total hip replacement ranges from 0.4 to 18.3 % and
• activity-limiting thigh pain is still an existing problem linked to the femoral component of uncemented hip replacement in up to 1.9 to 40.9 % of cases in some series.1

Doctors at the Mayo Clinic writing in the Journal of bone and joint surgery suggest that 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 (surgery to adjust or replace the hip socket component).

In looking to suggest treatment options the Mayo doctors looked at 49 patients with a diagnosis of iliopsoas impingement after primary total hip arthroplasty

• 21 patients underwent acetabular revision,
• 8 patients underwent tenotomy,
• and 20 patients had nonoperative management (conservative treatments).

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.

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.

• The greater the hardware problem the greater the need for surgical resolution.2

1 Fink B, Lass R. [Diagnostic Algorithm for Failure Analysis of Painful Total Hip Arthroplasties]. Z Orthop Unfall. 2016 Oct;154(5):527-544. Epub 2016 Oct 11. [Pubmed]

2 Chalmers BP, Sculco PK, Sierra RJ, Trousdale RT, Berry DJ. Iliopsoas Impingement After Primary Total Hip Arthroplasty: Operative and Nonoperative Treatment Outcomes. J Bone Joint Surg Am. 2017 Apr 5;99(7):557-564. [Pubmed]