{"id":4965,"date":"2025-11-26T09:14:58","date_gmt":"2025-11-26T09:14:58","guid":{"rendered":"https:\/\/www.chirurgiedelahanche.com\/blog\/role-paroi-anterieure-cotyle-dans-douleurs-inguinales-apres-prothese-de-hanche\/"},"modified":"2025-11-27T09:50:54","modified_gmt":"2025-11-27T09:50:54","slug":"role-of-anterior-acetabular-wall-in-groin-pain-after-total-hip-replacement","status":"publish","type":"post","link":"https:\/\/www.chirurgiedelahanche.com\/en\/blog\/hip-surgery\/role-of-anterior-acetabular-wall-in-groin-pain-after-total-hip-replacement\/","title":{"rendered":"The role of the anterior acetabular wall in groin pain after total hip replacement"},"content":{"rendered":"<p><img decoding=\"async\" class=\"aligncenter wp-image-4969 size-full\" src=\"https:\/\/www.chirurgiedelahanche.com\/app\/uploads\/2025\/11\/cover-role-of-anterior-acetabular-wall-in-groin-pain-after-total-hip-replacement-inside-the-hip-scaled.jpg\" alt=\"anterior acetabular wall \" width=\"2560\" height=\"1977\" srcset=\"https:\/\/www.chirurgiedelahanche.com\/app\/uploads\/2025\/11\/cover-role-of-anterior-acetabular-wall-in-groin-pain-after-total-hip-replacement-inside-the-hip-scaled.jpg 2560w, https:\/\/www.chirurgiedelahanche.com\/app\/uploads\/2025\/11\/cover-role-of-anterior-acetabular-wall-in-groin-pain-after-total-hip-replacement-inside-the-hip-300x232.jpg 300w, https:\/\/www.chirurgiedelahanche.com\/app\/uploads\/2025\/11\/cover-role-of-anterior-acetabular-wall-in-groin-pain-after-total-hip-replacement-inside-the-hip-1024x791.jpg 1024w, https:\/\/www.chirurgiedelahanche.com\/app\/uploads\/2025\/11\/cover-role-of-anterior-acetabular-wall-in-groin-pain-after-total-hip-replacement-inside-the-hip-768x593.jpg 768w, https:\/\/www.chirurgiedelahanche.com\/app\/uploads\/2025\/11\/cover-role-of-anterior-acetabular-wall-in-groin-pain-after-total-hip-replacement-inside-the-hip-1536x1186.jpg 1536w, https:\/\/www.chirurgiedelahanche.com\/app\/uploads\/2025\/11\/cover-role-of-anterior-acetabular-wall-in-groin-pain-after-total-hip-replacement-inside-the-hip-2048x1581.jpg 2048w, https:\/\/www.chirurgiedelahanche.com\/app\/uploads\/2025\/11\/cover-role-of-anterior-acetabular-wall-in-groin-pain-after-total-hip-replacement-inside-the-hip-300x232@2x.jpg 600w\" sizes=\"(max-width: 2560px) 100vw, 2560px\" \/><\/p>\n<h2>Understanding groin pain after total hip replacement<\/h2>\n<p><strong><a href=\"https:\/\/www.chirurgiedelahanche.com\/en\/treatments\/custom-made-hip-prosthesis\/\"> Total hip replacement<\/a><\/strong> is primarily indicated for advanced <strong><a href=\"https:\/\/www.chirurgiedelahanche.com\/en\/pathologies\/coxarthrosis\/\"> coxarthrosis<\/a> <\/strong>and aims to restore a <strong>mobile, stable, and pain-free hip<\/strong>. However, postoperative <strong>mechanical groin pain<\/strong> is not uncommon, particularly among young or athletic patients. In most cases, these symptoms subside within weeks or months.<\/p>\n<p>When groin pain persists after hip replacement, imaging is required to identify potential issues with the prosthesis such as <strong>loosening, migration, or infection<\/strong>. An <strong>ultrasound examination<\/strong> is also recommended to assess the soft tissues around the hip. It often reveals <strong>psoas tendinopathy<\/strong>, sometimes associated with <strong>bursitis<\/strong>, and can include <strong>dynamic tests<\/strong> to detect impingement between the psoas tendon and a mechanical obstacle.<\/p>\n<h2>First-Line conservative treatments<\/h2>\n<p>If bursitis or tendinopathy is diagnosed, a <strong>corticosteroid injection<\/strong> into the psoas bursa, performed under ultrasound guidance, is often proposed. This procedure frequently leads to significant improvement or even complete resolution of groin pain. If the pain persists, further investigations are necessary.<br \/>\nA <strong>CT scan<\/strong> helps confirm the presence of psoas impingement against a mechanical obstacle, which may be caused by an <strong>anterior bony osteophyte<\/strong> or by direct <strong>mechanical conflict with the prosthetic cup<\/strong>.<\/p>\n<h2>The essential role of CT imaging in analyzing the anterior wall<\/h2>\n<p>CT imaging is crucial for assessing the <strong>positioning of the acetabular cup<\/strong> , which may reveal <strong>oversizing, retroversion, or malposition<\/strong> .<br \/>\nIt also allows detailed evaluation of a key structure for proper prosthetic function &#8211; the <strong>anterior bony wall of the acetabulum<\/strong> .<\/p>\n<p>The acetabulum is bordered by two very different bony walls:<\/p>\n<ul>\n<li>The <strong>posterior wall<\/strong>, thick and dense<\/li>\n<li>The <strong>anterior wall<\/strong>, thin and fragile<\/li>\n<\/ul>\n<p>During hip replacement (especially using <strong>minimally invasive techniques<\/strong> ) excessive reaming may lead to <strong>partial or total destruction<\/strong> of the anterior wall. This risk is particularly high in <strong>osteoporotic or <\/strong><a href=\"https:\/\/www.chirurgiedelahanche.com\/en\/pathologies\/dysplasia\/\"><strong>dysplastic<\/strong><\/a><strong> patients<\/strong>.<\/p>\n<p>When the anterior wall is deficient, the <strong>prosthetic cup may come into direct contact with the psoas tendon<\/strong>, leading to inflammation, pain, and weakness during active hip flexion.<\/p>\n<h2>Surgical options for mechanical conflict<\/h2>\n<p>Several <strong>surgical approaches<\/strong> can be considered when persistent groin pain is linked to a mechanical conflict.<\/p>\n<h3>Arthroscopic treatment<\/h3>\n<p><strong>Hip arthroscopy<\/strong> can be used to remove bony impingement (e.g., anterior osteophyte) or eliminate contact with cement or a polyethylene liner.<br \/>\nIn some cases, arthroscopy is performed to <strong>release the psoas tendon<\/strong> ( <i> tenotomy <\/i> ). While this can relieve pain, it carries significant drawbacks:<\/p>\n<ul>\n<li>Permanent weakness of active hip flexion<\/li>\n<li>Persistent residual pain<\/li>\n<li>Risk of <strong>anterior instability<\/strong> of the hip<\/li>\n<\/ul>\n<h2>The Inside the Hip approach: preserving the tendon, treating the cause<\/h2>\n<p>At <i> Inside the Hip <\/i> , <strong>psoas tenotomy is generally avoided<\/strong>. The surgical team prefers to <strong>preserve the tendon<\/strong> and <strong>address the underlying cause<\/strong> of the impingement.<br \/>\nA <strong>revision hip surgery<\/strong> is performed through an <strong>anterior approach<\/strong>, allowing the surgeon to reposition the cup anatomically, without oversizing or retroversion.<\/p>\n<p>When the <strong>anterior acetabular wall is damaged<\/strong>, a <strong>bone graft<\/strong> may be used to reconstruct it, enabling optimal cup positioning and effectively eliminating the conflict and associated psoas pain.<\/p>\n<h2>Preventing groin pain: the key to success<\/h2>\n<p>Preventing cup\u2013psoas impingement and preserving the anterior wall relies on <strong>three-dimensional (3D) preoperative planning<\/strong> based on CT imaging. Only a CT scan can determine the precise <strong>cup diameter<\/strong> suitable for the patient\u2019s anatomy, thus avoiding oversizing.<\/p>\n<p>During implantation, <strong>visual control of the anterior acetabular wall<\/strong> is essential to ensure it remains intact. Correct <strong>anatomical cup positioning<\/strong> , shielded from the tendon, helps prevent any mechanical conflict that could lead to groin pain.<\/p>\n<p>Performing a \u201cblind\u201d surgery through an excessively small incision may appear aesthetically appealing but poses a significant <strong>mechanical risk<\/strong>. Ultimately, in hip surgery, <strong>mechanics must prevail over cosmetics<\/strong>.<\/p>\n","protected":false},"excerpt":{"rendered":"<p> After a total hip replacement, some patients experience persistent groin pain, particularly during flexion movements. While such discomfort usually resolves spontaneously within a few weeks, lasting pain may reveal a deeper mechanical conflict. At  <i> Inside the Hip <\/i>, a center specialized in hip surgery in Lyon, special attention is given to the  <strong>anterior wall of the acetabulum<\/strong>, a key structural element for proper joint function whose alteration may be responsible for postoperative groin pain. <\/p>\n","protected":false},"author":35,"featured_media":4967,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[67],"tags":[],"class_list":["post-4965","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-hip-surgery"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.3 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>The role of the anterior acetabular wall in groin pain after total hip replacement | Paris and Lyon | Inside the Hip<\/title>\n<meta name=\"description\" content=\"After a total hip replacement, some patients experience persistent groin pain, particularly during flexion movements. 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While such discomfort usually resolves spontaneously within a few weeks, lasting pain may reveal a deeper mechanical conflict.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.chirurgiedelahanche.com\/en\/blog\/hip-surgery\/role-of-anterior-acetabular-wall-in-groin-pain-after-total-hip-replacement\/\" \/>\n<meta property=\"og:site_name\" content=\"Inside The Hip\" \/>\n<meta property=\"article:published_time\" content=\"2025-11-26T09:14:58+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2025-11-27T09:50:54+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/www.chirurgiedelahanche.com\/app\/uploads\/2025\/11\/listing-role-of-anterior-acetabular-wall-in-groin-pain-after-total-hip-replacement-inside-the-hip.jpg\" \/>\n\t<meta property=\"og:image:width\" content=\"800\" \/>\n\t<meta property=\"og:image:height\" content=\"490\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"author\" content=\"Inside The Hip\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Inside The Hip\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"3 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/www.chirurgiedelahanche.com\\\/en\\\/blog\\\/hip-surgery\\\/role-of-anterior-acetabular-wall-in-groin-pain-after-total-hip-replacement\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/www.chirurgiedelahanche.com\\\/en\\\/blog\\\/hip-surgery\\\/role-of-anterior-acetabular-wall-in-groin-pain-after-total-hip-replacement\\\/\"},\"author\":{\"name\":\"Inside The Hip\",\"@id\":\"https:\\\/\\\/www.chirurgiedelahanche.com\\\/#\\\/schema\\\/person\\\/28634ecd2ffccce8295e509f62551fba\"},\"headline\":\"The role of the anterior acetabular wall in groin pain after total hip replacement\",\"datePublished\":\"2025-11-26T09:14:58+00:00\",\"dateModified\":\"2025-11-27T09:50:54+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/www.chirurgiedelahanche.com\\\/en\\\/blog\\\/hip-surgery\\\/role-of-anterior-acetabular-wall-in-groin-pain-after-total-hip-replacement\\\/\"},\"wordCount\":612,\"commentCount\":0,\"image\":{\"@id\":\"https:\\\/\\\/www.chirurgiedelahanche.com\\\/en\\\/blog\\\/hip-surgery\\\/role-of-anterior-acetabular-wall-in-groin-pain-after-total-hip-replacement\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/www.chirurgiedelahanche.com\\\/app\\\/uploads\\\/2025\\\/11\\\/listing-role-of-anterior-acetabular-wall-in-groin-pain-after-total-hip-replacement-inside-the-hip.jpg\",\"articleSection\":[\"Hip surgery\"],\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"https:\\\/\\\/www.chirurgiedelahanche.com\\\/en\\\/blog\\\/hip-surgery\\\/role-of-anterior-acetabular-wall-in-groin-pain-after-total-hip-replacement\\\/#respond\"]}]},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/www.chirurgiedelahanche.com\\\/en\\\/blog\\\/hip-surgery\\\/role-of-anterior-acetabular-wall-in-groin-pain-after-total-hip-replacement\\\/\",\"url\":\"https:\\\/\\\/www.chirurgiedelahanche.com\\\/en\\\/blog\\\/hip-surgery\\\/role-of-anterior-acetabular-wall-in-groin-pain-after-total-hip-replacement\\\/\",\"name\":\"The role of the anterior acetabular wall in groin pain after total hip replacement | Paris and Lyon | Inside the Hip\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/www.chirurgiedelahanche.com\\\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\\\/\\\/www.chirurgiedelahanche.com\\\/en\\\/blog\\\/hip-surgery\\\/role-of-anterior-acetabular-wall-in-groin-pain-after-total-hip-replacement\\\/#primaryimage\"},\"image\":{\"@id\":\"https:\\\/\\\/www.chirurgiedelahanche.com\\\/en\\\/blog\\\/hip-surgery\\\/role-of-anterior-acetabular-wall-in-groin-pain-after-total-hip-replacement\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/www.chirurgiedelahanche.com\\\/app\\\/uploads\\\/2025\\\/11\\\/listing-role-of-anterior-acetabular-wall-in-groin-pain-after-total-hip-replacement-inside-the-hip.jpg\",\"datePublished\":\"2025-11-26T09:14:58+00:00\",\"dateModified\":\"2025-11-27T09:50:54+00:00\",\"author\":{\"@id\":\"https:\\\/\\\/www.chirurgiedelahanche.com\\\/#\\\/schema\\\/person\\\/28634ecd2ffccce8295e509f62551fba\"},\"description\":\"After a total hip replacement, some patients experience persistent groin pain, particularly during flexion movements. 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