Author: Max Hardwick-Morris
Hardwick-Morris, Max, 2024 Prediction of Iliopsoas Tendonitis after Hip Arthroplasty, Flinders University, College of Science and Engineering
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In 2007, total hip arthroplasty (THA) was labelled as the ‘operation of the century’ in The Lancet. With all its advancements in surgical techniques and approaches, technology utilisation, and implant development, this operation has restored mobility and quality of life (QoL) to millions of people who are suffering from debilitating deterioration of their hip joint. Despite this, many patients still suffer devastating postoperative complications that require revision, such as dislocation, infection, or loosening. However, significant research has been directed towards these complications, and less research has been directed towards other sources of postoperative dissatisfaction, such as soft tissue complications. These soft tissue complications may or may not require revision of the components, but they do significantly impact QoL and reduce postoperative function.
One of the main reported soft tissue complications after hip arthroplasty surgery is iliopsoas tendonitis, which has several causes, but is mainly attributed to impingement between an exposed acetabular cup and the iliopsoas muscle, causing irritation. Despite its relatively high incidence of between 4-30%, which varies by the type of hip arthroplasty surgery and the population of patients being studied, this complication is under-studied. Most research in this area has focused on identifying the incidence of iliopsoas tendonitis from Level-IV evidence retrospective database studies or assessing the success of various treatment regimens. Almost no research has been conducted to identify preoperative risk factors for iliopsoas tendonitis, let alone research towards the development of computational simulations for iliopsoas tendonitis. The development of a computational simulation for identifying iliopsoas tendonitis has significant potential. It could be used diagnostically by providing surgeons with enhanced clinical information about a patient who is suffering from postoperative groin pain and assist in their determination of an appropriate treatment pathway. Moreover, it could be used preventatively by integrating the simulation into a preoperative planning system to identify when patients may be at increased risk of iliopsoas tendonitis, allowing for patient-specific changes to the planned component positions and orientations to reduce this risk.
This dissertation therefore sought to address this gap in the literature by developing a computational simulation that can detect impingement between the iliopsoas and acetabular cup in patients who have undergone hip arthroplasty surgery, and then use this simulation to identify preoperative risk factors that exacerbate the risk of iliopsoas tendonitis. The ultimate ambitions for this tool were two-fold. First, to be used diagnostically by enabling postoperative assessment of patients who are experiencing groin pain. It was hoped that feedback from these postoperative assessments would facilitate improved treatment selection for patients with iliopsoas tendonitis by providing surgeons with more information about the nature of patient’s groin pain. Second, it was anticipated for this tool to be integrated into a preoperative planning protocol to guide and optimise the positioning of components to reduce the incidence of iliopsoas tendonitis.
The outcome of this thesis is a simulation that has been developed and tested in both THA and hip resurfacing arthroplasty patients. This testing involved correlating the primary output of the model – iliopsoas impingement – against clinical outcomes in case-controlled investigations of symptomatic and asymptomatic patients. These studies found the simulation to be more accurate in the identification of iliopsoas tendonitis, as measured by its sensitivity, specificity, and area under the curve in receiver operating characteristic curves, than the typical approach of measuring the anterior prominence of the acetabular cup on a CT scan. Following this, the simulation was applied to the preoperative setting where it was used to identify preoperative risk factors that may exacerbate the risk of iliopsoas tendonitis. This study found that posterior pelvic tilt of 6.0° and a delta between the native femoral head diameter and acetabular cup diameter of 5.7mm were significant predictors of iliopsoas tendonitis. Having completed these studies, integration of this tool into the 360Hip™ preoperative planning software has commenced, and will become a routine aspect of this system’s optimised preoperative templating algorithm.
Keywords: iliopsoas tendonitis, total hip arthroplasty, THA, hip resurfacing arthroplasty, simulation
Subject: Surgery thesis
Thesis type: Doctor of Philosophy
Completed: 2024
School: College of Science and Engineering
Supervisor: Prof. Mark Taylor