FP14.6 Surgical Treatment of Iliopsoas Impingement After Primary Total Hip Arthroplasty: Prevalence and Risk Factors in a Large Single-Institution Cohort

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ID: 330970
2026
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Abstract
Abstract ICLA14 - The Extra-Articular Masterclass: Endoscopic Repairs, Ischiofemoral Fixes, and Complex Alignment, Auditorium A (BMCC Level 1), October 9, 2026, 14:00 - 16:00 Introduction Iliopsoas impingement (IPI) is an increasingly recognized cause of persistent groin pain and dysfunction after total hip arthroplasty (THA). The incidence of clinically important IPI requiring surgical treatment remains incompletely defined. For IPI refractory to conservative management surgical treatment options include acetabular revision, open tenotomy, or arthroscopic iliopsoas fractional lengthening and often is done years following initial symptom onset. As such, the true incidence of persistent IPI and associated risk factors resulting in subsequent surgical management are incompletely characterized. We sought to determine the prevalence of, and risk factors for, surgical IPI treatment after primary THA at a single high-volume institution. Materials and Methods We performed a retrospective review of all primary THAs done from 2010 to 2025 and identified subsequent surgical IPI procedures performed within our health system during the same period. Patient demographics, surgical approach, and implant specific criteria were evaluated. Univariable and multivariable Cox proportional hazards models were used to determine risk factors associated with surgical IPI treatment. Results Seventy-one Iliopsoas Impingement Management (IPIM) procedures were performed after 18,497 primary THAs (prevalence, 0.4%). The prevalence by surgical approach was 0.4% for direct anterior, 0.5% for lateral, and 0.3% for posterior approaches. In multivariable analysis, factors associated with surgical IPI treatment included female sex (hazard ratio [HR], 2.35; p=0.001), direct anterior approach compared with posterior approach (HR, 2.06; p=0.024), and younger age (HR, 0.97; p<0.001). Body mass index, acetabular component size, anteversion, and inclination were not associated with IPIM (p≥0.074 ). Conclusion Surgical treatment of IPI after primary THA was uncommon (0.4%) but not rare. Women, younger patients, and those treated with a direct anterior approach had a greater risk of subsequent surgical IPI treatment. These findings may assist in patient counseling and in setting expectations regarding the likelihood of iliopsoas-related reoperation after contemporary primary THA.
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Authors Mario Hevesi, Sandeep Yanamala, John Kelly, Rana Ahmad, Rafael J. Sierra, Mark W. Pagnano, Michael Taunton
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Journal Journal of hip preservation surgery
Year 2026
DOI
10.1093/jhps/hnag043.110
URL
https://doi.org/10.1093/jhps/hnag043.110
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