Iliopsoas Impingement After Total Hip Arthroplasty: A Review of Diagnosis and Management.

Iliopsoas impingement is a growingly acknowledged yet frequently overlooked cause of persistent groin pain after total hip arthroplasty (THA), occurring in a small percentage of patients undergoing the procedure. It typically results from mechanical irritation of the iliopsoas tendon by anterior acetabular component overhang, retained cement, long screws, or other prosthetic hardware. Clinically, patients report pain that worsens with active hip flexion, stair climbing, and transitioning from sitting to standing. Diagnosis involves a combination of clinical assessment, imaging techniques such as radiographs, CT scans, or ultrasound, and confirmatory image-guided diagnostic injections. Conservative management, including physiotherapy and corticosteroid injections, may offer temporary relief but is often insufficient for long-term resolution. Surgical options, particularly iliopsoas tenotomy or acetabular component revision, are indicated in refractory cases and have demonstrated high success rates with improved functional outcomes. Early recognition and appropriate intervention are critical for optimizing postoperative recovery and improving the quality of life in affected patients.