Iliopsoas Bursitis Managed with Endoscopic Bursectomy and Lesser Trochanter Decompression: A Case Report

Delayed Onset Iliopsoas Tendonitis With Intramuscular Hematoma Following Total Hip Arthroplasty

Iliopsoas tendonitis following total hip arthroplasty (THA) can be challenging to diagnose due to the many causes of postoperative groin pain. This case involves a 66-year-old female with right-sided hip and groin pain and a palpable mass, 3 years post-THA. Initial recovery was unremarkable until the sudden onset of symptoms after exercise. The patient presented with a palpable mass on the groin area and pain and underwent several consults with general surgery and orthopaedics. A series of unremarkable radiogram, biopsies, and negative infectious workup prompted revision surgery, which included acetabular component revision and iliopsoas tenotomy. The patient experienced significant pain relief and improved mobility postrevision. This case highlights a complication of THA and the complexity of diagnosing and treating iliopsoas tendonitis post-THA.

Endoscopic Resection for Iliopectineal Bursitis Associated With Developmental Dysplasia of the Hip

Iliopectineal bursitis usually develops subsequent to other hip pathologies and can often be treated conservatively. However, when conservative treatment fails or the enlarged bursa causes pain or compression of the surrounding neurovascular structures, surgery may be required. Most previous studies have described open surgeries, and reports on endoscopy are very limited. We present a case of iliopectineal bursitis associated with developmental dysplasia of the hip (DDH) that was successfully treated endoscopically. A 16-year-old female with a one-year history of right inguinal pain was referred to our department. She was diagnosed with a hip ganglion and treated with needle aspiration nine times by her previous doctor. Radiographs revealed bilateral DDH without narrowing of the joint space. Magnetic resonance imaging revealed a distinct mass in the deep layer of the iliopsoas muscle, and communication between the mass and the hip joint was observed on ultrasonography. Endoscopic debridement and resection were performed based on the diagnosis of iliopectineal bursitis. We partially debrided the medial side of the rectus femoris muscle toward the deep layer and resected the bursa. We observed a burst of concentrated content from the bursa and confirmed the disappearance of the mass by intraoperative ultrasonography. The postoperative course was good, and there were no functional restrictions or symptom recurrence at two-year postoperatively. Endoscopic resection for repetitive iliopectineal bursitis without an intraarticular procedure does not induce hip instability in patients with DDH and is a minimally invasive cosmetic procedure, and superior to open surgery, especially in young women.

It’s Not Always the Appendix: An Unusual Case of Right Lower Quadrant Pain in an Emergency Department Patient Due to Iliopsoas Bursitis From Uncommon Sleep Positioning

Patients presenting to the emergency department (ED) with right lower quadrant pain will typically have acute appendicitis at the top of a limited differential. We present an unusual case of right lower quadrant pain in a 45-year-old female emergency department patient. She was referred from primary care for evaluation of suspected appendicitis with a final diagnosis of iliopsoas bursitis caused by sleep positioning. Knowledge of the appropriate evaluation and treatment of this unusual ED presentation is important for accurate diagnosis and appropriate referral to avoid unnecessary patient morbidity.