Risk Factors for Iliopsoas Impingement Following Total Hip Arthroplasty: A Systematic Review
Bibliographic record
Abstract
Background: Iliopsoas impingement (IPI) is an increasingly recognized cause of persistent groin pain following total hip arthroplasty (THA), often resulting from mechanical conflict between the iliopsoas tendon and the anterior rim of the acetabular component. Despite its clinical relevance, risk factors contributing to IPI remain poorly defined. Methods: A systematic search of PubMed, Embase, Scopus, and the Cochrane Library was conducted according to PRISMA guidelines. Studies were eligible if they evaluated adult patients undergoing primary THA and reported at least one risk factor associated with IPI. Only studies with a clearly defined clinical diagnosis of IPI were included. Data extraction and risk of bias assessments were performed independently by two reviewers. Risk of bias in each study was assessed through the Newcastle-Ottawa Scale. Results: Twelve observational studies met the inclusion criteria. Diagnosis of IPI was based on clinical symptoms of anterior groin pain exacerbated by hip flexion; 9 studies confirmed diagnosis with anesthetic injections. Key surgical risk factors included anterior cup prominence (ORs 1.16–35.20), oversized cups (cup-to-head ratio > 1.2, OR = 5.39, or ≥6 mm difference, OR = 26.00), decreased cup inclination, collared stem protrusion (OR = 13.89), and acetabular screw protrusion > 6.4 mm. Patient-specific risk factors included female sex (ORs 2.56, 2.79), higher BMI (OR = 1.07), younger age, previous hip arthroscopy (OR = 9.60) and spinal fusion (OR = 4.60). The anterolateral approach was also associated with higher IPI risk when compared to the posterior approach (OR = 4.20). Conclusions: IPI after THA is a multifactorial complication influenced by modifiable surgical variables and patient-specific anatomy. Careful preoperative planning, precise implant positioning, and attention to individual risk factors are essential to reduce IPI incidence and improve outcomes.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.007 | 0.034 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.008 | 0.008 |
| Bibliometrics | 0.009 | 0.010 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".