Disclosures: Eric A. Liu, DO: No financial relationships or conflicts of interest

Case Description: A 67-year-old female with a history of atrial fibrillation on xarelto initially presented to the outpatient clinic with persistent left hip pain and weakness. History was notable for a left total hip arthroplasty two months prior. Post-operative course was unremarkable, and she was discharged with home therapy. One month after the operation, patient was evaluated at outpatient therapy and noticed to have difficulty flexing her left hip. Radiographs of the joint were reportedly normal with no signs of aseptic loosening or component failure. Due to persistent left hip pain and weakness, patient was referred to our outpatient clinic for further evaluation.

Setting: Outpatient Clinic at an Academic Rehabilitation Hospital

Patient: 67-year-old female who presents with hip pain and focal weakness following total hip arthroplasty Assessment/

Results: Initial examination was significant for weakness of the left hip flexors. MRI was ordered which showed mild edema within the marrow of the proximal femur and acetabulum, soft tissue edema anterior to the hip, and mild L3-4 central stenosis. Electrodiagnostic study was conducted for further workup which showed no evidence of a left lower extremity peripheral neuropathy or radiculopathy. Patient was clinically diagnosed with iliopsoas tendonitis and prescribed aquatic therapy after failing initial land-based exercises.

Discussion: Iliopsoas tendinitis remains a rare source of persistent pain and weakness following total hip arthroplasty. Incidence can range between 0.3% to 4.3% and is commonly associated with an oversized or retroverted acetabular cup. Due to the focal weakness of the hip flexors, MRI and electrodiagnostics were ordered to rule out hematoma and neuropathy. Literature review has demonstrated that tenotomy of the iliopsoas and revision of the acetabular component can provide successful outcomes if conservative management fails.

Conclusion: Iliopsoas tendinitis is a relatively uncommon condition and should be considered in patients who present with persistent pain and focal hip flexor weakness following total hip arthroplasty.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/iliopsoas-tendonitis-following-total-hip-arthroplasty-a-case-report/