High Satisfaction Despite 32% Persistent Hip Flexor Weakness After Endoscopic Tenotomy for Iliopsoas Impingement Following Total Hip Arthroplasty
Bibliographic record
Abstract
BACKGROUND: Iliopsoas impingement (IPI) is a serious complication after total hip arthroplasty (THA), causing chronic pain and functional impairment. Endoscopic iliopsoas tenotomy (EIT) is considered among the least invasive options to prevent implant revision. This study aimed to evaluate postoperative outcomes with a focus on pain relief, objective hip flexor strength, and patient satisfaction. We hypothesized that patients would report high satisfaction despite potential persistent strength deficits. METHODS: This retrospective, consecutive, monocentric, single-surgeon level III study with prospective outcome evaluation included 31 THA patients (mean age 63 years, 18 women/13 men, mean body mass index (BMI) 28) treated with EIT for IPI between 2015 and 2022. The mean follow-up was 37.0 months (range, 24 to 82). The IPI was based on clinical findings and 3-Tesla metal artifact reduction sequences (MARS)-magnetic resonance imaging (MRI), and other causes of painful THA were excluded. Outcome measures included pain (visual analog scale (VAS)), Harris Hip Score (HHS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and standardized isometric hip flexion strength testing using a dynamometer, performed on the operated and contralateral limbs in all patients. RESULTS: Pain improved significantly (VAS 8.3 ± 1.3 to 2.9 ± 2.3, P < 0.001) with a postoperative HHS of 75.8 ± 15.8 and WOMAC of 66.2 ± 23.7. Hip flexor strength on the operated side was reduced by 32.4% (Fmax) and 32.6% (Fmean) compared to the contralateral side (P < 0.001), corresponding to a mean limb symmetry index (LSI) of 67.4%. Bilateral THA (11 patients) or previous hip surgeries (six patients) had no effect on pain relief or strength outcomes. Despite this measurable strength deficit, 26 patients, including those who had greater 8-mm cup overhang, were satisfied and would choose surgery again. CONCLUSIONS: Endoscopic iliopsoas tenotomy is a minimally invasive treatment option for symptomatic IPI, providing high patient satisfaction through reliable pain relief. However, hip flexor weakness may persist and should be discussed during preoperative counseling.
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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 | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 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".