Open Access
Issue
SICOT-J
Volume 6, 2020
Article Number 27
Number of page(s) 3
Section Hip
DOI https://doi.org/10.1051/sicotj/2020025
Published online 10 July 2020

© The Authors, published by EDP Sciences, 2019

Licence Creative Commons
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Introduction

Iliopsoas impingement was originally described after total hip arthroplasty by impingement with the metallic rim of a cup [1, 2], metallic heads (metal-on-metal bearings, hip resurfacing or hemiarthroplasty), screws [2], or pegs [3]. Poor anteversion of the cup or anterior cup prominence [4] is one of the main causes leading to iliopsoas impingement.

Large diameter mobile liner of a dual-mobility device was hypothesized in vitro as a new cause of iliopsoas impingement [57].

Case presentation

In 2015, a 67-year-old woman complained of hip pain for 5 years. She underwent a primary THA using an anterior approach. A dual mobility device (Tornier, France) was implanted: cup size was 46 mm, head size was 22 mm and a lateralized Meije stem (Tornier) (Figure 1).

thumbnail Figure 1

Anteroposterior radiograph of the pelvis showing the right Total Hip Arthroplasty.

She was doing well during one year after surgery.

One year later, she complained of anterior hip pain during flexion, difficulties to get into her car, and extreme pain when climbing stairs. Physical examination was typical of iliopsoas impingement: groin pain with resisted hip flexion and resisted straight-leg raise. In order to confirm our hypothesis, we performed an ultrasonography and an arthro-CT-scan.

Ultrasonography found soft-tissue impingement of the large diameter mobile liner with the iliopsoas tendon (Figure 2). Pain was felt by the patient when the US probe was placed on the iliopsoas tendon at the area of contact with the polyethylene liner.

thumbnail Figure 2

Lateral radiograph of the right total hip arthroplasty.

An arthro-CT scan was performed and showed that the liner impinged with the iliopsoas tendon (Figure 3). Cup is well anteversed, small size, and well centered. Therefore, nothing about cup orientation could lead to iliopsoas impingement.

thumbnail Figure 3

(A) Ultrasonography showing the DM liner (small arrow) and the iliopsoas tendon (big arrow). Arthro-CT-scan: impingement between the DM liner (small arrows and iliopsoas tendon (big arrow) showed in the sagittal (B), coronal oblique (C) and axial plane (D).

Discussion

To the best of our knowledge, this case report is the first to report an in vivo impingement between the liner of a DM device and the iliopsoas tendon. Moreover, we originally describe the ability to diagnose this new phenomenon using ultrasonography and arthro-CT-scan.

Iliopsoas impingement was often described with the metallic rim of the cup [4, 8] or screws [2] and pegs [3]. But this is the very first description in literature of iliopsoas impingement with the mobile liner of a DM device. This phenomenon is very rare as it was never reported before in large cohort of patients with DM cups [9].

Firstly, in 2015, Varadarajan et al. [7] stated that the two main drawbacks with DM were intra-prosthetic dislocation and anterior hip pain. Following the study of Cobb et al. [10], they theorized that reducing the liner profile of a DM device would decrease the rate of anterior hip pain by impingement with the iliopsoas tendon.

In 2016, Nebergall et al. [5] assessed the damage of dual-mobility liner rims in 15 retrieved polyethylenes. In retrieved liners, they found liner rim deformation at a mean 3-year follow-up and they hypothesized that it was due to inhibition of the liner mobility. In a cadaver model, they reported that liner motion was disturbed because of impingement with the iliopsoas tendon.

Then, in 2018, Zumbrunn et al. [6] performed a finite element analysis showing that an anatomical contoured DM liner would avoid the impingement with the iliopsoas tendon.

All these preliminary studies are in favor of a possible impingement between the PE liner of a DM device and the iliopsoas tendon.

Conclusion

This case report dealt with an original case of impingement between a DM liner and iliopsoas tendon. Further studies will be conducted to study the in vivo motion of the liner during daily tasks. Revision of patients complaining of anterior hip pain would help us to confirm our hypothesis.

Conflict of interest

The authors have no conflict of interest in relation to this paper. AV is consultant for Serf and Smith & Nephew and MHF receives royalties from Serf and DePuy outside the submitted work.

Funding

No funding was received for the submitted work.

Acknowledgments

This work was performed within the framework of the LABEX PRIMES (ANR-11-LABX-0063) of Université de Lyon, within the program “Investissements d’Avenir” (ANR-11-IDEX-0007) operated by the French National Research Agency (ANR).

References

  1. Lequesne M, Dang N, Montagne P, Lemoine A, Witvoet J (1991) Conflict between psoas and total hip prosthesis. Rev Rheum Mal Osteoarctic 58, 559–64 (in French). [Google Scholar]
  2. Bricteux S, Beguin L, Fessy MH (2001) Iliopsoas impingement in 12 patients with a total hip arthroplasty. Rev Chir Orthop Reparatrice Appar Mot 87 (8), 820–5. [PubMed] [Google Scholar]
  3. Viste A, Chatelet J-C, Fessy MH (2018) Pegs and dual mobility cup, in: La double mobilité « en marche » dans les prothèses totales de hanche, Elsevier Masson. (Cahiers d’enseignement de la SOFCOT). [Google Scholar]
  4. Chalmers BP, Sculco PK, Sierra RJ, Trousdale RT, Berry DJ (2017) Iliopsoas Impingement After Primary Total Hip Arthroplasty: Operative and Nonoperative Treatment Outcomes. J Bone Joint Surg Am. 99 (7), 557–64. [CrossRef] [PubMed] [Google Scholar]
  5. Nebergall AK, Freiberg AA, Greene ME, Malchau H, Muratoglu O, Rowell S, et al. (2016) Analysis of Dual Mobility Liner Rim Damage Using Retrieved Components and Cadaver Models. J Arthroplasty 31 (7), 1595–602. [CrossRef] [PubMed] [Google Scholar]
  6. Zumbrunn T, Patel R, Duffy MP, Rubash HE, Malchau H, Freiberg AA, et al. (2018) Cadaver-Specific Models for Finite-Element Analysis of Iliopsoas Impingement in Dual-Mobility Hip Implants. J Arthroplasty 33 (11), 3574–80. [CrossRef] [PubMed] [Google Scholar]
  7. Varadarajan KM, Zumbrunn T, Duffy MP, Patel R, Freiberg AA, Rubash HE, et al. (2016) Reducing the distal profile of dual mobility liners can mitigate soft-tissue impingement and liner entrapment without affecting mechanical performance. J Orthop Res 34 (5), 889–97. [CrossRef] [PubMed] [Google Scholar]
  8. Batailler C, Bonin N, Wettstein M, Nogier A, Martres S, Ollier E, et al. (2017) Outcomes of cup revision for ilio-psoas impingement after total hip arthroplasty: Retrospective study of 46 patients. Orthop Traumatol Surg Res 103 (8), 1147–53. [Google Scholar]
  9. Vermersch T, Viste A, Desmarchelier R, Fessy M-H (2015) Prospective longitudinal study of one hundred patients with total hip arthroplasty using a second-generation cementless dual-mobility cup. Int Orthop 39 (11), 2097–101. [CrossRef] [PubMed] [Google Scholar]
  10. Cobb JP, Davda K, Ahmad A, Harris SJ, Masjedi M, Hart AJ (2011) Why large-head metal-on-metal hip replacements are painful: the anatomical basis of psoas impingement on the femoral head-neck junction. J Bone Joint Surg Br 93 (7), 881–5. [CrossRef] [PubMed] [Google Scholar]

Cite this article as: Fessy MH, Riglet L, Gras L-L, Neyra H, Pialat J-B & Viste A (2020) Ilio-psoas impingement with a dual-mobility liner: an original case report and review of literature. SICOT-J 6, 27

All Figures

thumbnail Figure 1

Anteroposterior radiograph of the pelvis showing the right Total Hip Arthroplasty.

In the text
thumbnail Figure 2

Lateral radiograph of the right total hip arthroplasty.

In the text
thumbnail Figure 3

(A) Ultrasonography showing the DM liner (small arrow) and the iliopsoas tendon (big arrow). Arthro-CT-scan: impingement between the DM liner (small arrows and iliopsoas tendon (big arrow) showed in the sagittal (B), coronal oblique (C) and axial plane (D).

In the text

Current usage metrics show cumulative count of Article Views (full-text article views including HTML views, PDF and ePub downloads, according to the available data) and Abstracts Views on Vision4Press platform.

Data correspond to usage on the plateform after 2015. The current usage metrics is available 48-96 hours after online publication and is updated daily on week days.

Initial download of the metrics may take a while.