Vastus Lateralis Transfer for Severe Hip Abductor Deficiency: A Salvage Procedure

Abstract

Abductor muscle deficiency can be a debilitating problem following hip arthroplasty surgery. We report outcomes of a novel method of abductor muscle function reconstruction surgery in patients with chronic, irreparable gluteus medius and minimus defects. Four consecutive patients who underwent our method of abductor reconstruction surgery were retrospectively reviewed. All patients had severe pain and positive Trendelenberg gait before surgery. the vastus lateralis (VL) muscle was raised on its neurovascular pedicle and transferred 12-14 centimetres by proximal translation. The proximal portion of VL was reattached via bony anchors to the external surface of the iliac wing just below the iliac crest. The distal portion of VL reattached to the lateral femoral shaft, lateral intermuscular septum, and the fascia of vastus intermedius. Average follow-up was 10 months (range 7-15 months). Three of the four patients report dramatic improvement in pain as measured by the visual analogue pain scale. The same three patients report being "extremely satisfied" with the pain relief achieved and "extremely satisfied" with the operation overall. Two patients reported being "extremely satisfied" with improvements in walking. Hip abduction power improved in all patients but to varying degrees. The results show that our method of VL transfer may be a viable option for patients with severe abductor deficiency. Modest but clinically relevant early results are seen.