Iliopsoas Irritation as Presentation of Head-Neck Corrosion After Total Hip Arthroplasty

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.

Key points

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Corrosion of modular components at the femoral neck remains a complication of total hip arthroplasty.
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The authors have found the iliopsoas sign (pain on resisted flexion of the hip) to be suggestive of femoral component corrosion.
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The operative reports were reviewed, and corrosion was documented at the head-neck junction in all cases. After the revisions, all iliopsoas tendonitis symptoms resolved.
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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.

Introduction

Total hip arthroplasty (THA) is generally a highly successful operation. However, occasionally patients do return with pain in the hip without an obvious cause, such as dislocation, fracture, wear, or infection. In evaluating the painful total hip, it is helpful to use the history and the physical examination to focus on the workup.

Modularity at the head-neck junction of the femoral component has been accepted as an option for adjusting the femoral component geometry since the late 1980s. There were initial concerns about fretting and crevice corrosion at the taper junctions, and these were reduced by design improvements. Nevertheless, corrosion from the femoral component remains a complication of THA. Recently Rush University published a case series of 10 patients demonstrating that there can be an adverse local tissue reaction after THA caused by corrosion at the head-neck taper. This corrosion is correlated with the unique laboratory finding of serum cobalt levels being elevated more than serum chromium levels.

The authors have found the iliopsoas sign (pain on resisted flexion of the hip) to be suggestive of the presence of femoral component corrosion. This physical examination test was originally described for the detection of appendicitis or iliopsoas abscess. The authors think the relationship of iliopsoas irritation and intraarticular corrosion may be caused by the close relationship of the iliopsoas and the joint capsule. In most hips, the joint capsule and the iliopsoas sheath are physically separated by the substantial ligaments of the hip: the iliofemoral, pubofemoral, and ischiofemoral ligaments. Occasionally there is a communication in a native hip between the hip capsule and the iliopsoas. After a THA, there is iatrogenic damage to the joint capsule that may lead to communication between the iliopsoas and the joint capsule.

The authors present a case series to demonstrate the relationship of a positive iliopsoas sign and/or iliopsoas sterile abscess to the presence of clinically important head-neck corrosion.

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