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Significant muscle damage after multiple revision total hip replacements through the direct lateral approach
P von Roth1, M P Abdel2, F Wauer1
1Charité Universitaetsmedizin , Center for Musculoskeletal Surgery, Department of Orthopedic Surgery, Charitéplatz 1, 10117 Berlin, Germany.
The Bone & Joint Journal
|December 3, 2014
Summary
Hip abductor muscle damage is progressive after total hip replacement (THR). Revision THR causes more gluteus medius fatty degeneration than primary THR, impacting hip function.
Area of Science:
- Orthopedic Surgery
- Musculoskeletal Imaging
- Biomedical Engineering
Background:
- Intact hip abductors are vital for normal gait and preventing limping.
- The direct lateral surgical approach is associated with abductor muscle trauma.
- The impact of revision total hip replacement (THR) on hip abductor integrity is not well understood.
Purpose of the Study:
- To prospectively evaluate the pre- and post-operative condition of the gluteus medius muscle after revision THR.
- To compare muscle damage and functional outcomes between revision THR and primary THR patients.
- To investigate the relationship between gluteus medius fatty degeneration and the Trendelenburg sign.
Main Methods:
- Prospective study comparing 30 revision THR patients with 15 primary THR patients.
- All surgeries utilized the direct lateral approach (Hardinge).
- Pre- and six-month post-operative MRI scans of the gluteus medius and functional analyses were performed.
Main Results:
- Mean gluteus medius fatty degeneration increased significantly after revision THR (35.8% to 41%, p=0.03) and primary THR (p=0.001), indicating progressive damage.
- Revision THR showed significantly more muscle damage compared to primary THR.
- A positive Trendelenburg sign increased post-revision THR (p=0.03), but showed no correlation with gluteus medius fatty degeneration (p=0.26).
Conclusions:
- Revision THR using the direct lateral approach leads to progressive gluteus medius muscle damage.
- While limping indicators like the Trendelenburg sign increase, direct correlation with fatty degeneration is not established.
- Further research into alternative surgical approaches for hip replacement is warranted.
