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 dif...
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| Format: | Article |
| Language: | English |
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Wiley
2025-07-01
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| Series: | Orthopaedic Surgery |
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| Online Access: | https://doi.org/10.1111/os.70021 |
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| author | Nikolai Ramadanov Maximilian Voss Robert Hable Robert Prill Dobromir Dimitrov Marco Ezechieli Ingo J. Banke Roland Becker |
| author_facet | Nikolai Ramadanov Maximilian Voss Robert Hable Robert Prill Dobromir Dimitrov Marco Ezechieli Ingo J. Banke Roland Becker |
| author_sort | Nikolai Ramadanov |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-d0d7f1d3d24b44119fc37ff02826e0d4 |
| institution | Kabale University |
| issn | 1757-7853 1757-7861 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Wiley |
| record_format | Article |
| series | Orthopaedic Surgery |
| spelling | doaj-art-d0d7f1d3d24b44119fc37ff02826e0d42025-08-20T03:29:14ZengWileyOrthopaedic Surgery1757-78531757-78612025-07-011771899191210.1111/os.70021Multilevel Meta‐Analysis of Treatment Options for Patients With Iliopsoas Impingement Syndrome After Total Hip ArthroplastyNikolai Ramadanov0Maximilian Voss1Robert Hable2Robert Prill3Dobromir Dimitrov4Marco Ezechieli5Ingo J. Banke6Roland Becker7Center of Orthopaedics and Traumatology Brandenburg Medical School, University Hospital Brandenburg an der Havel Brandenburg an der Havel GermanyCenter of Orthopaedics and Traumatology Brandenburg Medical School, University Hospital Brandenburg an der Havel Brandenburg an der Havel GermanyFaculty of Applied Computer Science Deggendorf Institute of Technology Deggendorf GermanyCenter of Orthopaedics and Traumatology Brandenburg Medical School, University Hospital Brandenburg an der Havel Brandenburg an der Havel GermanyDepartment of Surgical Diseases Faculty of Medicine, Medical University of Pleven Pleven BulgariaCenter of Orthopaedics and Traumatology Vincenz Hospital Paderborn Paderborn GermanyClinic of Orthopedics and Sports Orthopedics Klinikum Rechts der Isar, Technical University of Munich Munich GermanyCenter of Orthopaedics and Traumatology Brandenburg Medical School, University Hospital Brandenburg an der Havel Brandenburg an der Havel GermanyABSTRACT 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.https://doi.org/10.1111/os.70021acetabular cup revisionconservative managementendoscopic tenotomyiliopsoas impingementmeta‐analysistotal hip arthroplasty |
| spellingShingle | Nikolai Ramadanov Maximilian Voss Robert Hable Robert Prill Dobromir Dimitrov Marco Ezechieli Ingo J. Banke Roland Becker Multilevel Meta‐Analysis of Treatment Options for Patients With Iliopsoas Impingement Syndrome After Total Hip Arthroplasty Orthopaedic Surgery acetabular cup revision conservative management endoscopic tenotomy iliopsoas impingement meta‐analysis total hip arthroplasty |
| title | Multilevel Meta‐Analysis of Treatment Options for Patients With Iliopsoas Impingement Syndrome After Total Hip Arthroplasty |
| title_full | Multilevel Meta‐Analysis of Treatment Options for Patients With Iliopsoas Impingement Syndrome After Total Hip Arthroplasty |
| title_fullStr | Multilevel Meta‐Analysis of Treatment Options for Patients With Iliopsoas Impingement Syndrome After Total Hip Arthroplasty |
| title_full_unstemmed | Multilevel Meta‐Analysis of Treatment Options for Patients With Iliopsoas Impingement Syndrome After Total Hip Arthroplasty |
| title_short | Multilevel Meta‐Analysis of Treatment Options for Patients With Iliopsoas Impingement Syndrome After Total Hip Arthroplasty |
| title_sort | multilevel meta analysis of treatment options for patients with iliopsoas impingement syndrome after total hip arthroplasty |
| topic | acetabular cup revision conservative management endoscopic tenotomy iliopsoas impingement meta‐analysis total hip arthroplasty |
| url | https://doi.org/10.1111/os.70021 |
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