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Abductor function after total hip replacement. An electromyographic and clinical review
1University Department of Orthopaedic Surgery, Bristol Royal Infirmary, England.
The Journal of Bone and Joint Surgery. British Volume
|January 1, 1989
Summary
Total hip replacement outcomes vary by surgical approach. The modified direct lateral approach showed better abductor function, especially with proper trochanteric sliver healing, compared to direct lateral or posterior methods.
Area of Science:
- Orthopedic Surgery
- Biomechanics
- Rehabilitation Medicine
Background:
- Total hip replacement (THR) is a common procedure to alleviate hip pain and improve function.
- Surgical approach selection can influence postoperative outcomes, particularly hip abductor muscle function.
- Understanding the impact of different THR approaches on muscle integrity and recovery is crucial for patient management.
Purpose of the Study:
- To compare the electromyographic and clinical outcomes of three total hip replacement approaches: modified direct lateral, direct lateral, and posterior.
- To evaluate the incidence of Trendelenburg test positivity and abductor weakness across the different surgical groups.
- To investigate the correlation between trochanteric sliver healing and abductor function in the modified direct lateral approach.
Main Methods:
- Electromyographic and clinical assessments were conducted on patients three months post-total hip replacement.
- Patients were categorized based on surgical approach: modified direct lateral (29 hips), direct lateral (29 hips), and posterior (21 hips).
- The Trendelenburg test was used to assess abductor muscle function, and radiological evaluation examined trochanteric sliver union status.
Main Results:
- The direct lateral approach resulted in a higher rate of positive Trendelenburg tests (Grade II) compared to the modified direct lateral and posterior approaches.
- Abductor weakness was observed in a small percentage of hips across all groups, with no significant statistical difference in denervation rates.
- In the modified direct lateral group, radiological union of the trochanteric sliver was significantly associated with superior abductor function.
Conclusions:
- The modified direct lateral approach for total hip replacement may offer advantages in preserving abductor function compared to the direct lateral approach.
- Trochanteric sliver healing is a critical factor for optimal abductor muscle recovery following the modified direct lateral approach.
- Further research into surgical techniques that ensure trochanteric union could enhance functional outcomes after hip replacement.