Corrosion of modular components at the femoral neck remains a complication of total hip arthroplasty (THA). The authors have found the iliopsoas sign (pain on resisted flexion of the hip) to be suggestive of femoral component corrosion. These cases represented 8 of 120 revision hip arthroplasties (7%) performed at the authors’ institution. After the revisions, all iliopsoas tendonitis symptoms resolved. Based on the authors’ experience and the recent literature, they recommend that the iliopsoas sign or presentation of a sterile iliopsoas abscess in a previously well-functioning THA be concern for corrosion of the femoral component of the total hip.
Based on the authors’ experience and the recent literature, they recommend that the iliopsoas sign or presentation of a sterile iliopsoas abscess in a previously well-functioning total hip arthroplasty be concern for corrosion of the femoral component of the total hip.
Based on the authors’ experience and the recent literature, they recommend that the iliopsoas sign or presentation of a sterile iliopsoas abscess in a previously well-functioning total hip arthroplasty be concern for corrosion of the femoral component of the total hip.
From a retrospective review of the authors’ records from May 29, 2012 to April 23, 2014, they identified 8 hips having revision arthroplasty for a concern of corrosion, with corrosion identified at the revision procedure. The authors’ suspected patients with corrosion preoperatively as having elevated cobalt over chromium levels, MRI findings of a pseudotumor, and iliopsoas symptoms. Iliopsoas symptoms were defined as examination findings of severe groin pain with resistance of hip flexion. Some patients exhibited a sterile psoas abscess that required either aspiration or drainage. Intraoperatively, corrosion was defined as a finding of black debris between the trunnion and the femoral head and identifiable metallosis debris in the soft tissue.
Certainly the incidence of the diagnosis of corrosion will increase along with the number of total hips in the general population. Clinical awareness of iliopsoas findings in patients with THA and pain of unexplained cause deserves a workup described in this article and by the group at Rush.
Summary
Based on the authors’ experience and the recent literature, they recommend that the iliopsoas sign or presentation of a sterile iliopsoas abscess in a previously well-functioning THA be concern for corrosion of the femoral component of the total hip. Patients presenting with this sign after a THA merit further evaluation for the possibility of corrosion. Diagnostic workup includes obtaining serum cobalt and chrome levels to look for corrosion, C-reactive protein and sedimentation rate to rule out infection, a metal-suppression MRI to evaluate for iliopsoas involvement, ALVAL, or other soft tissue involvement. Early surgical intervention is warranted in the face of elevated cobalt over chrome levels and especially with positive findings on MRI with MARS.
The authors present their series with physical findings that may aid the orthopedic surgeon in a prompt diagnosis that can prevent further soft tissue injury.
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