PSOAS TENDONITIS IN DAA ANTHONY S UNGER MD

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PSOAS TENDONITIS IN DAA ANTHONY S UNGER, MD WASHINGTON, DC

PSOAS TENDONITIS IN DAA ANTHONY S UNGER, MD WASHINGTON, DC

ANTHONY S UNGER, MD • DISCLOSURES – INNOMED—ROYALTIES – ZIMMER/BIOMET– ROYALTIES, CONSULTANT – STRYKER—CONSULTANT,

ANTHONY S UNGER, MD • DISCLOSURES – INNOMED—ROYALTIES – ZIMMER/BIOMET– ROYALTIES, CONSULTANT – STRYKER—CONSULTANT, SPEAKER – SIGNATURE ORTHOPAEDICS-STOCK HOLDER, ROYALTIES – J OF ARTHROPLASTY-EDITORIAL BOARD – ARTHROPLASTY TODAY-EDITOR BOARD

IS ANTERIOR GROIN PAIN A PROBLEM AFTER DAA? ? ? • YES---BUT PREVENTABLE

IS ANTERIOR GROIN PAIN A PROBLEM AFTER DAA? ? ? • YES---BUT PREVENTABLE

PSOAS TENDONITIS=GROIN PAIN

PSOAS TENDONITIS=GROIN PAIN

ANTERIOR OVERHANG>8 MM • Iliopsoas Impingement After Primary Total Hip Arthroplasty: Operative and Nonoperative

ANTERIOR OVERHANG>8 MM • Iliopsoas Impingement After Primary Total Hip Arthroplasty: Operative and Nonoperative Treatment Outcomes • • Chalmers, Brian P. ; Sculco, Peter K. ; Sierra, Rafael J. ; Trousdale, Robert T. ; Berry, Daniel J. Copyright © 2017 The Journal of Bone and Joint Surgery, Inc. All rights reserved • JBJS. 99(7): 557 -564, April 5, 2017. • doi: 10. 2106/JBJS. 16. 00244 8

HISTORY • ANTERIOR GROIN PAIN UPON RISE FROM CHAIR OR STAIR CLIMB • USUALLY

HISTORY • ANTERIOR GROIN PAIN UPON RISE FROM CHAIR OR STAIR CLIMB • USUALLY AFTER 6 -12 WEEKS POST OP

PHYSICAL EXAM • PAINLESS PASSIVE ROM • PAIN ON SLR OR ACTIVE FLEXION •

PHYSICAL EXAM • PAINLESS PASSIVE ROM • PAIN ON SLR OR ACTIVE FLEXION • PAIN ON PALPATION OVER PSOAS TENDON

IMAGING • XRAY-AP AND X-TABLE LATERAL • MRI-MARS • ULTRASOUND GUIDED INJECTION

IMAGING • XRAY-AP AND X-TABLE LATERAL • MRI-MARS • ULTRASOUND GUIDED INJECTION

PREVENTION • HOLD PT UNTIL 6 WEEKS • NO OPEN CHAIN HIP FLEXION IN

PREVENTION • HOLD PT UNTIL 6 WEEKS • NO OPEN CHAIN HIP FLEXION IN FIRST 6 WEEKS • WORK WITH KNOWLEDGABLE PT

PT for DAA is DIFFERENT !!

PT for DAA is DIFFERENT !!

PREVENTION • NO ANTERIOR OVERHANG • BURY CUP • SAVE MEDIAL CAPSULE? ?

PREVENTION • NO ANTERIOR OVERHANG • BURY CUP • SAVE MEDIAL CAPSULE? ?

CUP OVERHANG>8 MM Iliopsoas Impingement After Primary Total Hip Arthroplasty: Operative and Nonoperative Treatment

CUP OVERHANG>8 MM Iliopsoas Impingement After Primary Total Hip Arthroplasty: Operative and Nonoperative Treatment Outcomes Chalmers, Brian P. ; Sculco, Peter K. ; Sierra, Rafael J. ; Trousdale, Robert T. ; Berry, Daniel J. JBJS. 99(7): 557 -564, April 5, 2017. doi: 10. 2106/JBJS. 16. 00244 Copyright © 2017 The Journal of Bone and Joint Surgery, Inc. All rights reserved 20

ANTERIOR OVERHANG>8 MM • Iliopsoas Impingement After Primary Total Hip Arthroplasty: Operative and Nonoperative

ANTERIOR OVERHANG>8 MM • Iliopsoas Impingement After Primary Total Hip Arthroplasty: Operative and Nonoperative Treatment Outcomes • • Chalmers, Brian P. ; Sculco, Peter K. ; Sierra, Rafael J. ; Trousdale, Robert T. ; Berry, Daniel J. Copyright © 2017 The Journal of Bone and Joint Surgery, Inc. All rights reserved • JBJS. 99(7): 557 -564, April 5, 2017. • doi: 10. 2106/JBJS. 16. 00244 21

REVISE CUP Copyright © 2017 The Journal of Bone and Joint Surgery, Inc. All

REVISE CUP Copyright © 2017 The Journal of Bone and Joint Surgery, Inc. All rights reserved • Iliopsoas Impingement After Primary Total Hip Arthroplasty: Operative and Nonoperative Treatment Outcomes • • Chalmers, Brian P. ; Sculco, Peter K. ; Sierra, Rafael J. ; Trousdale, Robert T. ; Berry, Daniel J. • JBJS. 99(7): 557 -564, April 5, 2017. • doi: 10. 2106/JBJS. 16. 00244 23

NON-OP RX • NSAI • PT • GUIDED INJECTION – STEROID – BOTOX –

NON-OP RX • NSAI • PT • GUIDED INJECTION – STEROID – BOTOX – PRP? ?

HIP SCOPE

HIP SCOPE

CONCLUSION • IN OR-- WATCH OUT FOR ANTERIOR IMPINGEMENT • HOLD THE PT •

CONCLUSION • IN OR-- WATCH OUT FOR ANTERIOR IMPINGEMENT • HOLD THE PT • FOLLOW THE ALGORITHIM : RELEASE PSOAS for <8 mm AND/OR REVISE CUP FOR >8 mm in CHRONIC CASES

PSOAS TENDONITIS IN DAA ANTHONY S UNGER MDPSOAS TENDONITIS IN DAA ANTHONY S UNGER MD
Daa 3 k Results daa 3 k gncDaa 3 k Results daa 3 k gnc
Designated Approval Agency DAA Annual Meeting DAA AnnualDesignated Approval Agency DAA Annual Meeting DAA Annual
NANOTECHNOLGIA BARBORA BELASOV DAA FEKOV DAA KRAFKOV 1NANOTECHNOLGIA BARBORA BELASOV DAA FEKOV DAA KRAFKOV 1
NANOTECHNOLGIA BARBORA BELASOV DAA FEKOV DAA KRAFKOV 1NANOTECHNOLGIA BARBORA BELASOV DAA FEKOV DAA KRAFKOV 1
THE DIRECT ANTERIOR HIP REPLACEMENT ANTHONY S UNGERTHE DIRECT ANTERIOR HIP REPLACEMENT ANTHONY S UNGER
Bursitis Tendonitis Fibromyalgia Objectives 1 Explain how bursitisBursitis Tendonitis Fibromyalgia Objectives 1 Explain how bursitis
ACHILLES TENDONITIS AND RUPTURE Dr Carl Clinton noACHILLES TENDONITIS AND RUPTURE Dr Carl Clinton no
ARTHROSCOPIC ACROMIOPLASTY Angela Whittington DEFINITION Bursitis or tendonitisARTHROSCOPIC ACROMIOPLASTY Angela Whittington DEFINITION Bursitis or tendonitis
Rotator Cuff Tendonitis BY CATHY BESMAR Synonyms toRotator Cuff Tendonitis BY CATHY BESMAR Synonyms to
Bursitis Tendonitis Fibromyalgia and RSD Joe Lex MDBursitis Tendonitis Fibromyalgia and RSD Joe Lex MD
TRAUMATIC TENDONITIS MAYCEE RIDER TARLETON STATE UNIVERSITY RADIOLOGYTRAUMATIC TENDONITIS MAYCEE RIDER TARLETON STATE UNIVERSITY RADIOLOGY
Tendonitis and Bursitis Thomas Mullin MD CAQSM DisclosureTendonitis and Bursitis Thomas Mullin MD CAQSM Disclosure
Psoas abscess due to community acquired methicillinresistant StaphylococcusPsoas abscess due to community acquired methicillinresistant Staphylococcus
Prognostic Value of Psoas Muscle Area and DensityPrognostic Value of Psoas Muscle Area and Density
Psoas Major It arises from the roots ofPsoas Major It arises from the roots of
Muscle Review Psoas Major O Lumbar Vert IMuscle Review Psoas Major O Lumbar Vert I
LendenDarmbeinmuskel musculus iliopsoas Ursprung Der Lendenmuskel musculus psoasLendenDarmbeinmuskel musculus iliopsoas Ursprung Der Lendenmuskel musculus psoas
Psoas major 1 processi transversi L 1 LPsoas major 1 processi transversi L 1 L
DRAINAGE COELIOSCOPIQUE DE LABCES DU PSOAS PAR VOIEDRAINAGE COELIOSCOPIQUE DE LABCES DU PSOAS PAR VOIE
ABCES DU PSOAS CAUSE TUMORALE COLIQUE DROITE DrABCES DU PSOAS CAUSE TUMORALE COLIQUE DROITE Dr
Nervy doln konetiny topografie2 PLEXUS LUMBALIS TOPO psoasNervy doln konetiny topografie2 PLEXUS LUMBALIS TOPO psoas
SECONDARY ABSCESSES OF THE PSOAS ABOUT 15 CASESSECONDARY ABSCESSES OF THE PSOAS ABOUT 15 CASES
LE Anterior thigh iliopsoas Psoas major Origin InsertionLE Anterior thigh iliopsoas Psoas major Origin Insertion