FP8.2 The Psoas Wrap Angle

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ID: 331063
2026
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Abstract
Abstract ICLA08 - AI and 3D Simulations: Trustworthy Clinical Partners or Tech Hype?, Auditorium B (BMCC Level 1), October 8, 2026, 14:00 - 16:00 Background Iliopsoas pain remains a persistent complaint in a subset of patients following Total Hip Arthroplasty (THA). In some instances it may appear 6 months to several years after the index surgery. Despite well-positioned acetabular components with no anterior exposure, a patient cohort continues to experience psoas pain after surgery. This study aims to present a simple biomechanical pulley model defining the path of the iliopsoas to simulate how component positioning and hip mobility impact the reaction force generated. Methods 100 consecutive Computed Tomography (CT) scans of patients requiring THA were obtained. 3D models of the pelvis, sacrum, L5 and proximal femur were segmented using the 3D Slicer imaging computing platform. Within the software, two vectors defined from three landmarks were measured: the Psoas origination at the distal lumbar spine, the pectineal eminence of the Pelvis and its insertion at the lesser trochanter of the femur. The Psoas Wrap Angle (PWA) was then defined as the resulting angle between the two vectors. Functional pelvic tilt was measured in the standing and supine positions. Transformation algorithms were applied to the landmarks to simulate the effect of common THA correction parameters such as Leg Length (LL), Lateral Offset (LO), Anterior Offset (AO) and Femoral Version (FV). Results In the standing position, patients had a mean PWA (Psoas Wrap Angle) of 125.2±6.3°, which was significantly different (P<0.05) to the mean supine PWA of 127.5±5.2°. PWA is reduced by an average 0.6° for every 1° of posterior pelvic rotation. Patients with high native FV (≥20°) had a significantly (p<0.05) more acute mean PWA of 123.5±6.1° compared to 127.5±6.1° for low FV patients. Conclusion The PWA is a patient-specific variable that is defined by the anatomy and impacted by the functional position of the hip-spine-femur relationship. Acute PWA (a smaller angle) may result in a heightened reaction force experienced by the iliopsoas at its contact point of the anterior pelvis. Patients with high native FV presented with more acute PWA values. THA corrections which increase FV and decrease AO present a worst-case scenario for increased reaction forces correlates to a more acute PWA. We hypothesize that these patients may therefore present with more anterior hip pain (psoas pain). This is analogous to an increased offset hip compared to the native hip resulting in possible greater trochanteric pain.
Reference Key
openalex_W7220389593 Use this key to autocite in the manuscript while using SciMatic Manuscript Manager or Thesis Manager
Authors Loïc Vercruysse, Lachlan Milne, Jitendra Balakumar, Dean Pinchen
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Journal Journal of hip preservation surgery
Year 2026
DOI
10.1093/jhps/hnag043.058
URL
https://doi.org/10.1093/jhps/hnag043.058
Keywords Keywords not found

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