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

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...

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Bibliographic Details
Published in:The Journal of arthroplasty 2010-04, Vol.25 (3), p.450-457.e1
Main Authors: Miozzari, Hermes H., MD, Dora, Claudio, MD, Clark, John M., MD PhD, Nötzli, Hubert P., MD
Format: Article
Language:English
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
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Summary: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.
ISSN:0883-5403
1532-8406
DOI:10.1016/j.arth.2008.12.010