Late Repair of Abductor Avulsion After the Transgluteal Approach for Hip Arthroplasty

• Published in: The Journal of arthroplasty Vol. 25; no. 3; pp. 450 - 457.e1
• Main Authors: Miozzari, Hermes H., MD, Dora, Claudio, MD, Clark, John M., MD PhD, Nötzli, Hubert P., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-04-2010
• Subjects: Adult; Aged; Arthroplasty, Replacement, Hip - adverse effects; Arthroplasty, Replacement, Hip - methods; Buttocks; common aponeurosis between gluteus medius and vastus lateralis; Female; Follow-Up Studies; Gait - physiology; hip abductors; Hip Prosthesis; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Muscle, Skeletal - pathology; Muscle, Skeletal - physiopathology; Muscle, Skeletal - surgery; Orthopedics; Pain - etiology; Reoperation; revision surgery; Surgical Wound Dehiscence - etiology; Surgical Wound Dehiscence - physiopathology; Surgical Wound Dehiscence - surgery; total hip arthroplasty; Treatment Outcome; Wound Healing - physiology; hip abductors; revision surgery; common aponeurosis between gluteus medius and vastus lateralis; total hip arthroplasty
• ISSN: 0883-5403; 1532-8406
• DOI: 10.1016/j.arth.2008.12.010

Abstract The abductor release sometimes does not heal after a transgluteal approach for hip arthroplasty. Factors influencing the success of subsequent repair are unclear. We used magnetic resonance imaging (MRI) to compare the condition of the gluteus medius with clinical outcome after late repair of abductor dehiscence in 12 total hip patients. Evaluation included a pain rating, gait evaluation, Trendelenburg test, strength grading, and Harris Hip Score. Most had both prerepair and postrepair MRI studies to assess the repair and to grade abductor muscle fatty degeneration. Two repairs without MRI were explored surgically. Although average pain, limp, and strength scores improved significantly, rerupture occurred in 4 subjects and fatty degeneration in the gluteus medius did not improve, even with intact repair. Nine patients were satisfied; 7 of these had an intact repair. Magnetic resonance imaging and operative observations suggest that chronic degeneration in the abductor mechanism is the major impediment to successful repair.