Clinical Scorecard: Alterations in Femoral Anteversion Linked to Ischiofemoral Impingement Following Total Hip Arthroplasty: A Retrospective CT Analysis

At a Glance

Key Highlights

• IFI manifests as buttock and groin pain due to quadratus femoris muscle compression post-THA.
• GTPS occurs in 4–17% of patients after THA, linked to abductor tendon damage or degeneration.
• Higher femoral anteversion after anterior approach THA is suspected to associate with IFI occurrence.

Guideline-Based Recommendations

Diagnosis

• Clinical diagnosis of IFI based on patient history, symptoms, and specific tests (long-stride walking test, IFI test).
• GTPS diagnosis based on symptoms and clinical tests (hip abduction/external rotation, FABER, resisted external rotation, Trendelenburg tests) per 2022 ISHA Physical Therapy Agreement.
• Confirmation requires imaging evidence: edema/fatty atrophy of quadratus femoris for IFI; abductor tendinopathy or trochanteric bursitis on ultrasound or MRI for GTPS.

Management

• Exclude other causes of hip pain post-THA such as aseptic loosening, infection, instability, periprosthetic fracture, or cup overhang.
• Consider femoral anteversion and offset changes in surgical planning and postoperative assessment to minimize IFI and GTPS risk.

Monitoring & Follow-up

• Postoperative CT imaging to assess femoral anteversion and femoral offset changes.
• Use MRI or ultrasound to monitor soft tissue changes indicative of IFI or GTPS.
• Clinical follow-up with orthopedic specialists experienced in hip surgery.

Risks

• Persistent or new hip pain after THA may be due to IFI or GTPS linked to altered femoral anteversion or abductor tendon damage.
• Female sex, surgical approach, and cup overhang are additional risk factors for GTPS.

Patient & Prescribing Data

Patients undergoing anterior approach total hip arthroplasty without complicating secondary conditions

Monitoring femoral anteversion changes via CT may help identify patients at risk for IFI; clinical and imaging evaluation is essential for accurate diagnosis and management of postoperative hip pain syndromes.

Clinical Best Practices

• Perform thorough clinical examination using standardized tests for IFI and GTPS in patients with postoperative hip pain.
• Utilize pre- and postoperative CT imaging to measure femoral anteversion and femoral offset accurately.
• Corroborate clinical findings with imaging evidence (MRI or ultrasound) to confirm diagnosis of IFI or GTPS.
• Exclude other causes of hip pain such as infection, loosening, or fracture before attributing symptoms to IFI or GTPS.
• Consider surgical approach and implant positioning to minimize alterations in femoral anteversion and offset.

References

• 1. Increase in THA procedures worldwide
• 2. Causes of hip pain after THA
• 3. Greater trochanteric pain syndrome (GTPS) prevalence
• 5. Pathophysiology of GTPS
• 6-9. Ischiofemoral impingement clinical features and imaging
• 10-13. Surgical and demographic factors affecting GTPS
• 14-17. Studies on femoral offset changes post-THA
• 18. Association of femoral anteversion with IFI
• 19-20. Clinical tests for IFI diagnosis
• 21. 2022 ISHA Physical Therapy Agreement for GTPS
• 22-23. Imaging signs of GTPS
• 24. Normative values for ischiofemoral space
• 25. Murphy et al method for femoral anteversion measurement