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The iliopsoas tendon can rub over the rim of the cup after a hip replacement. This typically causes groin pain when standing up, on stairs and when lifting the leg.
What is iliopsoas impingement?
The iliopsoas tendon runs right in front of the socket towards the thigh bone. When the cup of the implant protrudes slightly too far forward, the tendon rubs over that rim with every movement. This causes irritation and pain, known as iliopsoas impingement.
It occurs in about 4% of patients after a total hip replacement. It is one of the most missed causes of groin pain after a replacement, because the X-ray otherwise looks normal.
Possible symptoms
- Groin pain when lifting the leg, for example getting in and out of a car
- Pain when rising from a low chair or on stairs
- Difficulty putting on shoes and socks
- Sometimes a click or jolt in the groin
- The pain is absent at rest, which distinguishes it from an infection
Treatment
The diagnosis is confirmed with a CT scan measuring cup prominence and with an ultrasound-guided injection at the tendon.
- Targeted physiotherapy unloading the iliopsoas
- An ultrasound-guided injection that often confirms the diagnosis and gives relief
- Arthroscopic release of the tendon (psoas release)
- With a clearly prominent cup, a revision of the cup
See also iliopsoas tendinopathy for the form without a replacement.
Not sure where your complaints come from? Use the symptom explorer or book an appointment with one of our hip surgeons.
Frequently asked questions
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