Iliopsoas Impingement After Direct Anterior Approach Total Hip Arthroplasty: Epidemiology, Risk Factors, and Treatment Options

Background: The objective of this study is to evaluate the incidence, natural history, response to treatment, and risk factors for anterior iliopsoas impingement (AIPI) after direct anterior approach (DAA) total hip arthroplasty (THA). Methods: Between January 1, 2009 and January 4, 2014, 600 patients (655 hips) who underwent primary DAA THA were retrospectively reviewed. AIPI incidence was calculated. Natural history and response to a stepwise treatment approach was assessed. Radiographic anterior acetabular component overhang was measured. Asymptomatic controls were used to identify risk factors for the development of AIPI. Results: In total, 518 patients (559 hips) met the inclusion criteria. The incidence of AIPI was 32/559 (5.7%). Symptom resolution occurred in 22/32 (68.8%) patients at final follow-up. Nonoperative management was successful in 15/32 (46.9%) patients. Operative intervention resulted in symptom resolution in 5/8 (62.5%) patients. On univariate analysis, female gender (odds ratio [OR] 2.79), acetabular component to native femoral head diameter ratio above 1.1 (OR 3.85), and any measurable overhang (OR 7.07) significantly raised the risk of AIPI, while increasing native femoral head diameter was protective for AIPI (OR 0.83). Conclusion: AIPI is a cause of groin pain after DAA THA, which often improves with conservative measures. Significant predisposing factors for AIPI include female gender, small native femoral head diameter, increased acetabular component to femoral head diameter ratio, and most notably, any measurable acetabular component overhang. Level of Evidence: Level III, retrospective cohort study. (C) 2020 Elsevier Inc. All rights reserved.