Related Experiment Video
Updated: Jan 17, 2026
The Transition to an Anterior-Based Muscle Sparing Approach Improves Early Postoperative Function but is Associated with a Learning Curve
Published on: September 7, 2022
Arthroscopic Versus Open Iliopsoas Release After Total Hip Arthroplasty
Charles L Holliday1, Karissa N Simon1, Robert T Trousdale1
1Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A.
Purpose:
To evaluate the differences in clinical outcomes and complication rates between open and arthroscopic iliopsoas (IP) tenotomy between 1998 and 2023 at our institution.
Methods:
Patients who underwent arthroscopic iliopsoas fractional lengthening (IPFL) or open tenotomy for IP tendinitis following total hip arthroplasty (THA) between 1988 and 2023 were identified. Patients were excluded if they underwent revision IP tendon release, had additional concomitant procedures, or had less than a 24-month postoperative follow-up. Patient records were reviewed, and patient-reported outcomes were collected via electronic survey.
Results:
Fifty-two patients (36 arthroscopic, 16 open) were followed for an average of 68.7 (24.0-203.7) months. Overall surgery satisfaction was 7.9 (scale 0-10) following arthroscopic IPFL and 6.0 following open tenotomy (P = .178). Eighty-six percent of patients reported improvement in their anterior groin pain following arthroscopic IPFL, compared to 45% following open tenotomy (P = .065). In the arthroscopic cohort, 64% reported improved hip flexion strength, compared to 36% in the open cohort (P = .158). Visual analog scale for pain at rest was lower following arthroscopic IPFL (1.1 ± 2.2 vs 3.3 ± 3.2, P = .0092), while pain with use did not differ between cohorts (3.1 ± 1.3 vs 2.6 ± 1.1, P = .786). There were no differences in postoperative Tegner (3.1 ± 1.3 vs 2.6 ± 1.1, P = .302), modified Harris Hip Score (77.0 ± 19.0 vs 69.2 ± 26.9, P = .073), or Single Assessment Numeric Evaluation (70.9 ± 28.7 vs 66.7 ± 31.8, P = .571) scores between arthroscopic and open cohorts. Revision THA rates did not differ following arthroscopic or open procedures (8.3% vs 25%, P = .104).
Conclusions:
Patients have improved pain at rest following arthroscopic IPFL when compared to open tenotomy for IP tendinitis following THA. Overall complication and reoperation rates were low for both techniques.
Level Of Evidence:
Level III, retrospective cohort study.
