Arthroscopic vs. Open Treatments for Iliopsoas Tendinitis

For the vast majority of total hip arthroplasty patients, surgery eliminates their hip arthritis pain. However, in a small percentage of cases (roughly 0.5% to 4%), patients can develop a frustrating complication: lingering pain in the front of the groin. Often, this is due to a condition called iliopsoas tendinitis (or iliopsoas impingement). Simply put, the iliopsoas is a large tendon in the front of your hip that helps lift your leg. Sometimes, after a hip replacement, this tendon rubs against the new hip implant, becoming inflamed, painful, and weak.

When physical therapy, anti-inflammatory medications, and targeted injections don't solve the problem, we look toward surgery to release or lengthen the tight tendon. Historically, this meant an "open" surgery—creating a traditional incision to find and cut the tendon. Today, we can often perform this procedure "arthroscopically," using a tiny camera and specialized instruments through poke-hole incisions.

But which method is actually better for the patient?

A recent study from tour group sought to answer exactly that. We looked back at patients treated between 1998 and 2023 to compare the outcomes of open tendon release versus arthroscopic (minimally invasive) fractional lengthening.

Here is what the study found, and what it means for you:

1. Significantly Less Pain at Rest

The most striking finding was related to postoperative pain. Patients who underwent the minimally invasive arthroscopic procedure reported significantly less pain while resting compared to those who had the traditional open surgery. In fact, on a 10-point pain scale, the arthroscopic group averaged a score of just 1.1 at rest, compared to 3.3 for the open surgery group.

2. High Satisfaction and Better Function

Both surgeries were effective, but the arthroscopic approach showed an edge in overall patient perception. Overall, 86% of patients in the arthroscopic group reported improvement in their hip function, and 86% reported improvement in their anterior groin pain.

3. Few Patients Reported Loss of Strength

A common fear patients have when considering whether they should "release" a tendon is that they will lose their strength. Surprisingly, our study found the opposite. Following the arthroscopic release, 64% of patients actually reported improved hip flexion strength. As a surgeon, I see this often: once the debilitating, pinching pain is gone, your body stops guarding the hip, and secondary muscles naturally step up to do the work.

4. A Safe Approach

Both procedures proved to be very safe with low complication rates. However, the arthroscopic approach had a noticeably lower complication rate (5.6%) compared to the open procedure (18.8%).

The Bottom Line:

If you are dealing with a pinching, painful groin after a hip replacement, you don't necessarily just have to live with it. While conservative treatments are generally our first line of defense, modern minimally invasive arthroscopic techniques offer a generally safe and often effective way to relieve pain and get you back to enjoying your new hip.