Could the tendon degeneration and the fatty infiltration of the gluteus medius affect clinical outcome in total hip arthroplasty?

AbstractAbductor deficiency after total hip arthroplasty is a severe complication with functional limitations and a significant reduction in the patientʼs quality of life. Common causes are degenerative ruptures or approach-related iatrogenic damage to the gluteus medius and minimus muscle and the inferior gluteal nerve, fractures of the greater trochanter and incorrect reconstruction of leg length and femoroacetabular offset. With a standardised diagnosis consisting of a clinical examination, conventional X-ray and MRI, the causes of the functional problems can often be reliably determined. Therapy of abductor deficiency is challenging for both patients and physicians and is often tedious. However, with a clear diagnostic and therapeutic algorithm and straightforward patient education, good treatment results can be achieved even in this challenging condition. Conservative therapy with eccentric stretching and muscle strengthening are the basis of the treatment. In cases of progression of complaints despite intensive conservative treatment, various anatomical and extra-anatomical surgical reconstruction methods are available to relieve pain and improve function. Anatomical reconstruction of the gluteal tendon insertion is an option in cases of low-grade fatty infiltration and moderate retraction of the gluteal muscles. In situations with advanced degenerative changes in the gluteus medius and minimus muscles and an intact gluteus maximus muscle, transfer of the anterior portion of the gluteus maximus according to Whiteside is an option. For high-grade defects of the soft tissue, there is also the option of an isolated or combined transfer of the vastus lateralis muscle.

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Repair of Symptomatic Partial Gluteus Medius Tear During Total Hip Arthroplasty Through the Direct Anterior Approach

Arthroscopy Techniques ◽

10.1016/j.eats.2020.10.043 ◽

2021 ◽

Vol 10 (2) ◽

pp. e575-e580

Author(s):

David R. Maldonado ◽

Samantha C. Diulus ◽

Mitchell B. Meghpara ◽

Rachel M. Glein ◽

Hari K. Ankem ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Anterior Approach ◽

Gluteus Medius ◽

Direct Anterior Approach ◽

Total Hip

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Revision of total hip arthroplasty: Clinical outcome of extended trochanteric osteotomy and intraoperative femoral fracture

Technology and Health Care ◽

10.3233/thc-2008-16407 ◽

2008 ◽

Vol 16 (4) ◽

pp. 293-300 ◽

Cited By ~ 15

Author(s):

Matthias Lerch ◽

Gabriela von Lewinski ◽

Henning Windhagen ◽

Fritz Thorey

Keyword(s):

Total Hip Arthroplasty ◽

Clinical Outcome ◽

Hip Arthroplasty ◽

Femoral Fracture ◽

Trochanteric Osteotomy ◽

Total Hip ◽

Extended Trochanteric Osteotomy

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Effects of rehabilitation and arthroplasty on the hip isometric muscle strength in patients with osteoarthritis of the hip

Medicinski pregled ◽

10.2298/mpns0906236j ◽

2009 ◽

Vol 62 (5-6) ◽

pp. 236-240 ◽

Cited By ~ 1

Author(s):

Slavica Jandric

Keyword(s):

Muscle Strength ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Gluteus Medius ◽

Treated Group ◽

Early Rehabilitation ◽

Control Group ◽

Osteoarthritis Of The Hip ◽

Total Hip ◽

Tensor Fasciae Latae

Introduction Periarticular muscles have a significant role in keeping the mobility and integrity of the hip joint. The aim of this article was to investigate the effects of the total hip arthroplasty and early rehabilitation on the muscle strength. Patients Three groups of examined persons (matched in relation to musculosceletal conditions, sex, age and occupation) were included in the investigation. The first group (40 of the involved hip) and the second group (with 33 involved hips) were groups of patients with late-stage of osteoarthritis of the hip. The first group of patients was managed conservatively and the second group operatively (total cemented hip endoprosthesis was performed). The third group was control group with 123 healthy hips. Material and methods The maximal voluntary isometric strength was measured with dynamometer. The muscle strength was tested in all three groups: in the first group of patients at the beginning and at the end of the therapy and in patients of the second group 6?3 months postoperatively. Results A significant improvement of the muscle strength was noted for the flexors (t=2.45, p<0.05), musculus tensor fasciae latae (t=2.35, p<0.05), extensors (t=2.85, p<0.01), adductors (t=3.02, p<0.01), external rotators (t=3.1, p<0.01), m. gluteus medius (t=5.28, p<0.001) and internal rotators (t=5.77, p<0.001) after total hip arthroplasty and early rehabilitation in comparison to the conservatively treated group. Conclusion The muscle strength in the patients with osteoarthritis of the hip after arthroplasty was significantly higher than after rehabilitation for all hip muscles but did not reach values of the strength of the muscles in the corresponding control group.

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Additive Influence of Hip Offset and Leg Length Reconstruction on Postoperative Improvement in Clinical Outcome After Total Hip Arthroplasty

The Journal of Arthroplasty ◽

10.1016/j.arth.2017.08.007 ◽

2018 ◽

Vol 33 (1) ◽

pp. 156-161 ◽

Cited By ~ 21

Author(s):

Moritz M. Innmann ◽

Michael W. Maier ◽

Marcus R. Streit ◽

George Grammatopoulos ◽

Thomas Bruckner ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Clinical Outcome ◽

Hip Arthroplasty ◽

Leg Length ◽

Total Hip ◽

Additive Influence ◽

Postoperative Improvement

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5-Year Clinical and Radiographic Results of the Direct Anterior Approach for Total Hip Arthroplasty Using a Collared Cementless Femoral Short-Stem Prosthesis

Journal of Clinical Medicine ◽

10.3390/jcm11020346 ◽

2022 ◽

Vol 11 (2) ◽

pp. 346

Author(s):

Ali Darwich ◽

Kim Pankert ◽

Andreas Ottersbach ◽

Marcel Betsch ◽

Sascha Gravius ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Clinical Outcome ◽

Hip Arthroplasty ◽

Anterior Approach ◽

Hip Osteoarthritis ◽

Direct Anterior Approach ◽

Short Stem ◽

Total Hip ◽

The Mean

The aim of this study was to investigate the radiological and clinical outcome of the direct anterior approach (DAA) in total hip arthroplasty (THA) using a collared cementless femoral short-stem. This retrospective study included 124 patients with 135 THAs operated from 2014 to 2016 using a collared cementless triple tapered hydroxyapatite-coated femoral short-stem (AMIStem H Collared®, Medacta International, Castel San Pietro, Switzerland) implanted with a DAA. Follow-up was performed at three months, 12 months, and five years. Clinical outcome was assessed using the hip osteoarthritis outcome score (HOOS) and radiological analysis was done using conventional radiographs, which included evaluation of the femur morphology based on Dorr classification, of radiolucencies based on the Gruen zone classification and of stem subsidence. The mean age was 67.7 ± 11.3 years and the mean body mass index (BMI) was 27.4 ± 4.4 kg/m2. The stem survival rate at five years was 99.1% with one revision due to recurrent dislocations. Mean HOOS score improved from 40.9 ± 18.3 preoperatively to 81.5 ± 19.7 at three months, 89.3 ± 10.9 at 12 months, and 89.0 ± 14.0 at five years (all with p < 0.001). No significant correlations were found between age, femoral bone morphology, BMI and HOOS, and the appearance of relevant radiolucencies.

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Biomechanical reconstruction parameters obtained after direct anterior approach total hip arthroplasty do not compromise clinical outcome

European Journal of Orthopaedic Surgery & Traumatology ◽

10.1007/s00590-020-02727-x ◽

2020 ◽

Vol 30 (8) ◽

pp. 1463-1470

Author(s):

Carlo Trevisan ◽

Raymond Klumpp ◽

Stefano Piscitello ◽

Riccardo Compagnoni ◽

Roberto Grattieri ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Clinical Outcome ◽

Hip Arthroplasty ◽

Anterior Approach ◽

Direct Anterior Approach ◽

Total Hip ◽

Biomechanical Reconstruction

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Total Hip Arthroplasty Using Imageless Computer-Assisted Navigation—2-Year Follow-Up of a Prospective Randomized Study

Journal of Clinical Medicine ◽

10.3390/jcm9061620 ◽

2020 ◽

Vol 9 (6) ◽

pp. 1620

Author(s):

Richard Lass ◽

Boris Olischar ◽

Bernd Kubista ◽

Thomas Waldhoer ◽

Alexander Giurea ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Clinical Outcome ◽

Hip Arthroplasty ◽

Important Determinant ◽

Randomized Study ◽

Prospective Randomized Study ◽

Computer Assisted ◽

Total Hip ◽

Significant Difference

The purpose of this study is to compare computer-assisted to manual implantation-techniques in total hip arthroplasty (THA) and to find out if the computer-assisted surgery is able to improve the clinical and functional results and reduce the dislocation rate in short-terms after THA. We performed a concise minimum 2-year follow-up of the patient cohort of a prospective randomized study published in 2014 and evaluated if the higher implantation accuracy in the navigated group can be seen as an important determinant of success in total hip arthroplasty. Although a significant difference was found in mean postoperative acetabular component anteversion and in the outliers regarding inclination and anteversion (p < 0.05) between the computer-assisted and the manual-placed group, we could not find significant differences regarding clinical outcome or revision rates at 2-years follow-up. The implantation accuracy in the navigated group can be regarded as an important determinant of success in THA, although no significant differences in clinical outcome could be detected at short-term follow-up. Therefore, further long-term follow-up of our patient group is needed.

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