Multilevel Meta-Analysis of Treatment Options for Patients With Iliopsoas Impingement Syndrome After Total Hip Arthroplasty

Abstract

Objective: Iliopsoas impingement (IPI) syndrome is a significant complication following total hip arthroplasty (THA), often leading to pain and reduced hip function. Despite its clinical relevance, the optimal treatment strategy remains unclear, with varying success rates reported across different interventions. This study aims to compare four treatment options (endoscopic, acetabular cup revision, open tenotomy and conservative management) for patients with IPI syndrome after THA by comparing outcomes in terms of function, pain, complications, and reoperations through a multilevel meta-analysis.

Methods: A literature search was conducted in the following databases until 30 November 2024: PubMed, CENTRAL, Epistemonikos, and Embase. A frequentist multilevel meta-analysis was performed using a random effects model with an inverse variance and restricted maximum likelihood heterogeneity estimator with Hartung-Knapp adjustment. Means with 95% confidence intervals (CIs) were calculated separately in the four treatment groups. Then, a test for subgroup differences in multilevel meta-analysis was performed to determine whether there is a statistically significant difference between the means of the four groups.

Results: The systematic review included 15 studies with 425 patients. The test for subgroup differences showed no statistically significant difference between the four treatment subgroups in Harris Hip Score (HHS) post-intervention (F = 2.0; df = 3, 7; p = 0.20), in HHS difference (F = 2.0; df = 3, 6; p = 0.22), and in functional minimal clinically important differences (MCID) post-intervention (F = 1.0; df = 3, 2; p = 0.42). The conservative management group exhibited the lowest mean HHS (70.3 points).

Conclusions: Surgical interventions, including endoscopic tenotomy, acetabular cup revision, and open tenotomy, are effective in achieving meaningful functional improvements in IPI patients. While conservative management was the least effective of all treatment groups, the differences did not reach statistical significance.

Keywords

acetabular cup revision / conservative management / endoscopic tenotomy / iliopsoas impingement / meta-analysis / total hip arthroplasty

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