Overview
Tendinitis of the right hip adductor muscle, often affecting muscles such as the adductor longus and magnus, is a condition characterized by inflammation and irritation of the tendons connecting these muscles to the femur. This condition commonly arises post-total hip arthroplasty (THA) due to altered biomechanics, muscle imbalances, and potential nerve injuries, but can also occur in athletes or individuals with repetitive strain injuries. Clinically significant due to its impact on mobility, pain, and functional limitations, it predominantly affects middle-aged to elderly individuals post-THA and athletes involved in activities requiring hip adduction strength, such as soccer and other sports involving kicking and lateral movements. Early recognition and management are crucial in preventing complications like gait abnormalities, muscle weakness, and potential prosthetic complications, making it essential for clinicians to accurately diagnose and treat to ensure optimal recovery and functional outcomes 134.Pathophysiology
The pathophysiology of tendinitis in the hip adductor muscles often stems from repetitive microtrauma or acute injury leading to localized inflammation and degeneration of the tendon. Post-THA, biomechanical alterations play a pivotal role: surgical interventions can disrupt the natural muscle balance around the hip, leading to compensatory overuse and strain on the adductor muscles. Specifically, changes in muscle lengths and moment arms, as observed in studies using dual fluoroscopic imaging systems (DFIS), can exacerbate these issues 1. Additionally, nerve injuries or limb shortening post-surgery can further compromise muscle function, contributing to tendinitis 6. In athletes, particularly those recovering from ACL reconstruction, biomechanical deficits and neuromuscular imbalances can similarly stress the adductor tendons, leading to tendinitis 2. The chronic nature of these imbalances can result in persistent tendon irritation and impaired healing, necessitating targeted rehabilitation strategies to restore normal function and reduce inflammation 34.Epidemiology
The incidence of hip adductor tendinitis post-THA is not extensively quantified in large population studies but is recognized as a significant complication affecting patient recovery and rehabilitation outcomes. It predominantly affects individuals undergoing THA for conditions like osteoarthritis, typically in the age range of 50 to 80 years, with females being slightly more represented due to higher rates of osteoarthritis in this demographic 1. Athletes, particularly those involved in sports requiring forceful hip adduction (e.g., soccer players), also face a notable risk, especially post-ACL reconstruction, where biomechanical deficits persist beyond typical recovery periods 2. Geographic and specific risk factors are less defined but may include pre-existing muscle imbalances, previous hip surgeries, and inadequate postoperative rehabilitation protocols. Trends suggest an increasing awareness and focus on biomechanical assessments post-THA to mitigate such complications, though comprehensive epidemiological data remain limited 12.Clinical Presentation
Patients with tendinitis of the right hip adductor muscle typically present with localized groin pain, often exacerbated by activities involving hip adduction such as walking, running, or kicking. Pain may radiate down the thigh and can be more pronounced during the stance phase of gait or when performing single-leg movements. Physical examination reveals tenderness over the adductor tendon insertion sites, with resisted adduction movements eliciting pain. There may be noticeable muscle weakness or altered gait patterns, such as a limp favoring the affected side. Red-flag features include significant swelling, warmth indicative of infection, or signs of neurological compromise, which would necessitate urgent further evaluation 145.Diagnosis
The diagnostic approach for hip adductor tendinitis involves a combination of clinical assessment and imaging modalities. Key steps include:Specific Criteria and Tests:
Management
Initial Management
Pharmacological Interventions
Advanced Interventions
Contraindications:
Complications
Prognosis & Follow-up
The prognosis for hip adductor tendinitis is generally favorable with appropriate management, often showing improvement within weeks to months. Key prognostic indicators include early diagnosis, adherence to rehabilitation protocols, and absence of underlying biomechanical issues. Recommended follow-up intervals typically include:Special Populations
Post-THA Patients
Athletes Post-ACL Reconstruction
Key Recommendations
References
1 Hu X, Zheng N, Hsu WC, Zhang J, Li H, Chen Y et al.. Adverse effects of total hip arthroplasty on the hip abductor and adductor muscle lengths and moment arms during gait. Journal of orthopaedic surgery and research 2020. link 2 Nagelli C, Wordeman S, Di Stasi S, Hoffman J, Marulli T, Hewett TE. Biomechanical Deficits at the Hip in Athletes With ACL Reconstruction Are Ameliorated With Neuromuscular Training. The American journal of sports medicine 2018. link 3 Yuce S, Dzhavadov AA, Dikmen G, Ozden VE, Kocabey B, Parvizi J et al.. Does Focused Gluteus Medius Muscle Stretching After Total Hip Arthroplasty Work? An Electromyographic Study. The Journal of arthroplasty 2025. link 4 Zarro M, Tamberrino K, Bane EM. Myositis Ossificans of the Adductor Longus in a Soccer Player. The Journal of orthopaedic and sports physical therapy 2020. link 5 Zhu MF, Musson DS, Munro JT. Hip abductor tendon tears-a survey of New Zealand orthopaedic surgeons. The New Zealand medical journal 2020. link 6 Hurwitz ZM, Montilla R, Dunn RM, Patel NV, Akyurek M. Adductor magnus perforator flap revisited: an anatomical review and clinical applications. Annals of plastic surgery 2011. link 7 Taher RT, Power RA. Iliopsoas tendon dysfunction as a cause of pain after total hip arthroplasty relieved by surgical release. The Journal of arthroplasty 2003. link