Rezidivierende Iliopsoaseinblutungen als Differenzialdiagnose bei chronischen Leistenschmerzen nach Hüfttotalendoprothesenimplantation

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• 作者：Dr. K.F. Braun (1)
  S. Siebenlist (1)
  G. Sandmann (1)
  F. Martetschl?ger (1)
  T. Kraus (1)
  S. Ehnert (2)
  M. Neumaier (1)
  T. Freude (2)
  U. St?ckle (2)
  
• 关键词：Iliopsoaseinblutung ; Hüfttotalendoprothese (H ; TEP) ; Leistenschmerz ; Sp?tkomplikation ; Flexionsdefizit ; Hematoma ; Iliopsoas muscle ; Total hip replacement (THP) ; Groin pain ; Delayed complication
• 刊名：Der Orthop?de
• 出版年：2012
• 出版时间：March 2012
• 年：2012
• 卷：41
• 期：3
• 页码：212-216
• 全文大小：647KB
• 参考文献：1. Ankarath S (2003) Pain related to the psoas muscle after total hip replacement. J Bone Joint Surg [Br] 85(8):1207
  2. Bartelt RB, Sierra RJ (2011) Recurrent hematomas within the ilioposas muscle caused by impingement after total hip arthroplasty. J Arthroplasty 26(4):665–e1- ternal" href="http://dx.doi.org/10.1016/j.arth.2010.04.002">CrossRef
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  11. Pouliot MA, Lee KB, Goodman SB (2009) Retroperitoneal hematoma: an unusual cause of pain after total hip arthroplasty. J Arthroplasty 24(7):1144.e 9-2 [Epub 2008 Oct. 9] ternal" href="http://dx.doi.org/10.1016/j.arth.2008.07.012">CrossRef
  12. Schuh A, Schraml A, Zeiler G (2003) Impingement of the iliopsoas muscle after revision of a loosened acetabular cup with an acetabular reinforcement ring. Zentralbl Chir 128(3):209-11 [case reports] ternal" href="http://dx.doi.org/10.1055/s-2003-38534">CrossRef
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• 作者单位：Dr. K.F. Braun (1)
  S. Siebenlist (1)
  G. Sandmann (1)
  F. Martetschl?ger (1)
  T. Kraus (1)
  S. Ehnert (2)
  M. Neumaier (1)
  T. Freude (2)
  U. St?ckle (2)
  
  1. Klinik und Poliklinik für Unfallchirurgie, Klinikum Rechts der Isar, Technische Universit?t München, Ismaninger Str. 22, 81675, München, Deutschland
  2. Berufsgenossenschaftliche Klinik Tübingen, Tübingen, Deutschland
  

文摘

Background Chronic and atraumatic groin pain may be due to a variety of pathologies local to and distal from the hip joint. Aside from frequent entities, such as inguinal hernia, impingement of the iliopsoas muscle by the anterior rim of the acetabular component leading to a hematoma can be a potential cause after total hip replacement (THR). Material and methods This article presents three cases of delayed groin pain after THR received due to osteoarthrosis of the hip joint several years prior to the onset of symptoms. In all three cases the patient suffered from chronic groin pain aggravated by active flexion without direct trauma. After thorough clinical, laboratory and radiological (ultrasound, x-ray, computed tomography) examination a hematoma of the iliopsoas muscle was detected. Furthermore, in all three cases the acetabular component appeared to be slightly malpositioned. Considering the least invasive procedure all cases were treated with an excavation of the hematoma. After recurrence the indications for revision of the malpositioned acetabular component were present. Results All patients clearly showed a reduction of pain after operative revision. There have been no further hematomas and the patients could be easily and rapidly remobilized. Conclusions Persistent atraumatic groin pain connected to a deficit in hip flexion after THR needs thorough investigation by the treating physician. The differential diagnosis of a delayed hematoma due to impingement of the iliopsoas muscle is a rare but more complex entity. After careful consideration of the perioperative risks an early indication for revision of a malpositioned acetabular component is promising.