Still Having Groin Pain After Your Hip Replacement? The Not-So-Uncommon Culprit You Should Know About
As an orthopedic surgeon, I often tell my patients that a total hip replacement is one of the most successful and life-changing procedures we have in modern medicine. For the vast majority of people, it eliminates years of arthritis pain and restores their active lifestyle. But what happens when the surgery is over, you’ve done all your physical therapy, and you are still experiencing a nagging, persistent pain in the front of your hip or groin? If you are dealing with this, you are not alone, and it is not "all in your head."
A recent research article published by our team in The Journal of Arthroplasty, sheds light on a frustrating but often treatable condition called Iliopsoas Tendonitis, also known as Iliopsoas Impingement.
What is Iliopsoas Tendonitis?
The iliopsoas is a large muscle that runs down the front of your pelvis and attaches to your thigh bone. It helps you lift your leg—like when you climb stairs, get out of a car, or stand up from a chair. Sometimes, after a hip replacement, this tendon can rub against the edge of the new hip socket. Over time, this constant friction can cause the tendon to become inflamed, irritated, and painful.
The Long Road to a Diagnosis
One of the most striking findings in the recent study was just how long it takes for patients to get an accurate diagnosis. We found that, on average, patients had this specific pattern of groin pain for over two years before being given a formal diagnosis of iliopsoas tendonitis.
During that time, most patients saw multiple different medical providers and tried various unsuccessful treatments prior to being seen and treated by our team. In fact, over half of the patients in the study traveled out of state for further care.
How Do We Fix It?
The good news is that once we identify the problem, treatment is often highly successful.
First, we usually confirm the diagnosis using a targeted, ultrasound-guided injection of numbing medicine and usually, a corticosteroid directly around the inflamed tendon. Most patients (with the correct diagnosis) report significant, immediate pain relief (averaging an 82% reduction in pain). This helps identify where the pain is coming from.
If the pain returns after the injection wears off, we often can offer a minimally invasive, arthroscopic surgery called an iliopsoas fractional lengthening. Through two small incisions, we use a small camera to locate the tight, inflamed tendon and carefully release or "lengthen" it. This helps remove the tension and stops it from rubbing against your hip implant.
Light at the End of the Tunnel
The results of this minimally invasive procedure are generally encouraging. In our study, patients reported substantial drops in their daily pain levels and significant improvements in their ability to perform daily activities. Overall surgical satisfaction was 8 out of 10, and nearly 90% of patients said they would undergo the same procedure again.
The bottom line:
Persistent groin pain after a hip replacement is not something you just have to live with. If you’ve been struggling to find answers, ask your orthopedic team about iliopsoas impingement. A simple diagnostic injection might just be the first step on your road to a better hip.
Check out the study for yourself Here.
