Reconstruction of gluteus medius muscle in revision total hip arthroplasty

Abstract

Objective The aim of this study is to observe the effect of our surgical treatment method for abductor defects in hip revision cases. Methods We retrospectively evaluated a consecutive series of eight patients (eight hips) with a defect of the hip gluteus medius muscle from April 2012 to April 2014 who underwent revision and gluteus medius muscle reconstruction. 7 patients with loosening of components (2 periprosthetic joint infections), 1 repeated dislocation after hemiarthroplasty. There was one case with moderate pain and 7 cases with severe pain. 8 cases were severe limp, needed crutches or braces walking aids, gluteal medius muscle strength was ≤3, and the Trendelenburg sign was positive in all patients. The average age was 50 years old (31-69 years old), 2 men and 6 women. One patient with a gluteus medius muscle completely disrupted from insertion at greater trochanter, which underwent knit suture. One patient had a greater trochanter fracture resulted in ascending of gluteus medius muscle. During revision, fracture was reducted and fixed by 2.0 Kirschner wire and cable. Three patients with defects of gluteus medius muscle; we applied gluteus maximus fascia lata muscle valvuloplasty. One patient with deficiency of both gluteus medius muscle and greater trochanter. Gluteus maximus was directly reattached to the proximal of femoral stem. Results All patients were followed up for an average of 18 months (range, 14-35 months). The mean Harris Hip score increased from 57 to 85, pain was remarkably relieved, ROM of hip and myodynamia was improved. Preoperative abductor strength ≤3, 6 months after surgery abductor strength was increased with average of 1-2 level. Conclusion Reconstruction of hip abductor tendon of gluteus medius muscle deficiency would be effective in hip revision surgery. Key words: Reoperation; Arthroplasty, replacement, hip; Treatment outcome