Groin Pain? Psoas Tendonitis?

"Psoas tendinitis is an important reason for groin pain in resurfacing surgery . This is peculiar to resurfacing as the cup for resurfacing is a very large profile ie half a sphere. Nearly all THR cups are only portions (arc) of a hemisphere.

Hence if the antero-posterior orientation i.e., version of the cup is marginally off the ideal, it would not be a problem with THR. However in resurfacing, due to the very large profile, if the version is less than ideal the ant edge of the cup will protrude out of the bony front wall of the acetabulum. The psoas tendon will rub on this and patients will typically complain of pain when attempting to lift their leg in a standing position.

For this reason we now take extra care to get the version right and most resurfacing surgeons leave a 3mm rim of osteophytes over the ant edge as a safety precaution to avoid this problem." Vijay Bose


SC Budithi; R Pollock; RK Logishetty; and AVF Nargol

University Hospital of North Tees.

Introduction: Pain after total hip arthroplasty (THA) can be caused by infection, aseptic loosening, heterotopic ossification, and referred pain. Psoas tendonitis is a rare cause of groin pain after THA and resurfacing arthroplasty. It is believed to be caused by psoas tendon impingement against a malpositioned acetabular component due to defective anteversion or centring and the use of oversized cups. We report 4 cases of psoas tendonitis following resurfacing arthroplasty and hybrid surface arthroplasty.

Methods: Between April 2004 and June 2005, we diagnosed 4 cases (3 female and 1 male) of psoas tendonitis among 152 cases of resurfacing arthroplasty and hybrid surface arthroplasty (2.6%). 116 patients had a hip resurfacing with ASR prosthesis (2 cases, 1.7%) and 36 patients had hybrid surface arthroplasty with ASR unipolar head on S ROM stem (2 cases, 5.6%). All these patients presented 2–5 months postoperatively with severe groin pain which was exaggerated when moving from the sitting position to the upright position and when going up stairs. Common causes of pain after hip arthroplasty, infection and loosening were ruled out. Radiological and ultrasound examination were performed.

Results: Ultrasound examination revealed thickening of psoas tendon in all cases and fluid collection around the tendon in one case. All cases were treated with corticosteroid injection under ultrasound guidance. Significant but temporary symptomatic relief was achieved in all cases.

Discussion: Psoas tendonitis should be considered in the differential diagnosis of groin pain after hip resurfacing procedures. Ultrasound examination is the initial investigation of choice and corticosteroid injection around the tendon is initial method of treatment. Computerized tomography and surgical options of management should be considered in resistant cases.


Correspondence should be addressed to The Secretary, BHS, c/o BOA, The Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PE.

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Updated February 2009