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Gallego-Peñalver F J, Cía-Blasco P, Gómez-Trullén E M. Unilateral Psoas Muscle Atrophy as a Possible Risk Factor for Low Back Pain After Total Hip Arthroplasty: A Case Report. jrehab 2025; 25 (4) :890-905
URL: http://rehabilitationj.uswr.ac.ir/article-1-3463-en.html

Introduction The psoas muscle plays an essential role in the hip and lumbar spine. Total hip arthroplasty surgery can change the ipsilateral psoas muscle, which may affect lumbar biomechanics and accelerate disk degeneration. We present a clinical study that suggests a potential association between unilateral psoas muscle atrophy after hip replacement surgery and subsequent low back pain
Case description A 53-year-old man with a history of right total hip arthroplasty for osteoarthritis presented with left lumbosciatalgia 6 years after surgery. In the physical examination, the patient exhibited weakness 2/5 in Kendall’s muscle grading system in the right hip flexion and left extensor hallucis longus and triceps surae. Magnetic resonance imaging revealed a degenerative disk L5-S1 and severe unilateral atrophy of the right psoas muscle. Conservative treatment through physiotherapy was initiated, but persistent pain ultimately necessitated microdiscectomy at the L5–S1 level.
Conclusion Total hip arthroplasty surgery may lead to long-term unilateral atrophy of the ipsilateral psoas muscle and alter lumbar biomechanics, potentially accelerating the disk degeneration and subsequent low back pain. Investigating this possible correlation may offer greater clarity regarding low back pain after total hip arthroplasty. In our case, conservative treatment through 15 sessions of physical therapy resulted in very limited improvement, and advanced diskopathy required surgical intervention to decompress the affected lumbar root.