tailieunhanh - Maheshwari et al. Journal of Orthopaedic Surgery and Research 2010, 5:6

Maheshwari et al. Journal of Orthopaedic Surgery and Research 2010, 5:6 CASE REPORT Open Access Rupture of the ilio-psoas tendon after a total hip arthroplasty: an unusual cause of radio-lucency of the lesser trochanter simulating a malignancy Aditya V Maheshwari1*†, Rajesh Malhotra2†, Deepak Kumar3†, J David Pitcher Jr1† Abstract Avulsion fracture or progressive radiolucency of lesser trochanter is considered a pathognomic finding in patients with malignancies. Although surgical release of the iliopsoas tendon may be required during a total hip arthroplasty (THA), there is no literature on spontaneous rupture of the ilio-psoas tendon after a THA causing significant functional impairment. We report here such. | Maheshwari et al. Journal of Orthopaedic Surgery and Research 2010 5 6 http content 5 1 6 JOURNAL OF ORTHOPAEDIC SURGERY AND RESEARCH CASE REPORT Open Access Rupture of the ilio-psoas tendon after a total hip arthroplasty an unusual cause of radio-lucency of the lesser trochanter simulating a malignancy Aditya V Maheshwari 1 3 Rajesh Malhotra23 Deepak Kumar33 J David Pitcher Jr13 Abstract Avulsion fracture or progressive radiolucency of lesser trochanter is considered a pathognomic finding in patients with malignancies. Although surgical release of the iliopsoas tendon may be required during a total hip arthroplasty THA there is no literature on spontaneous rupture of the ilio-psoas tendon after a THA causing significant functional impairment. We report here such a case which developed progressive radiolucency of the lesser trochanter over six years after a THA simulating a malignancy. The diagnosis was confirmed by MRI. Because of the chronic nature of the lesion gross retraction of the tendon into the pelvis and low demand of our patient he was treated by physiotherapy and gait training. Injury to the ilio-psoas tendon can occur in various steps of the THA and extreme care should be taken to avoid this injury. Prevention during surgery is better although there are no reports of repair in the THA setting. This condition should be considered in patients who present with progressive radioluceny of the lesser trochanter especially in the setting of a hip pelvic surgery. Awareness and earlier recognition of the signs and symptoms of this condition will aid in diagnosis and will direct appropriate management. Introduction Avulsion fracture of lesser trochanter of the femur is a well known entity in children and adolescents 1 . However its fracture or progressive radiolucency is considered a pathognomic finding in adults with malignancies 2 . Spontaneous rupture of ilio-psoas tendon is rare and has not been described before in the setting of a total

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