Reconstructive Surgical Techniques Research Articles

Techniques of hepatic arterial reconstruction in liver transplantation.

Hepatic artery reconstruction is an essential part of liver transplantation. This difficult stage of the operation is even more demanding in living donor liver transplantation than in deceased donor liver transplantation. One of the most important advances in hepatic artery reconstruction for living liver grafts was the introduction of microsurgical techniques involving an operative microscope or surgical loupe. Many surgical reconstruction techniques have been used in this field. In this article, first, we will talk about the hepatic artery reconstruction techniques that are frequently used in deceased donor liver transplantation, and afterward, we will talk about the hepatic artery reconstruction techniques used in living donor liver transplantation, which include the hepatic artery reconstruction technique we use and call "one stay corner suture technique". We think high-volume transplant centers should tend to develop a standardized technique for doing hepatic artery reconstruction with their teams. We think the "one stay corner suture technique" can be easily applied in centers that perform LDLT.

Medial Collateral Ligament and Posterior Oblique Ligament Reconstruction for Valgus Instability After Total Knee Arthroplasty

Medial collateral ligament (MCL) injuries are typically managed non-operatively, with high rates of clinical success. However, patients who present with medial knee laxity with valgus stress testing of a fully extended knee, anteromedial rotatory instability, associated tibial plateau fracture, or multiligament injury or those who continue to be symptomatic after non-operative treatment may benefit from surgical intervention. Patients with a history of total knee arthroplasty who suffer MCL and posterior oblique ligament (POL) injuries represent a challenging patient population and often require surgical attention. In this Technical Note, we describe the preoperative assessment, decision making, and surgical technique for anatomic reconstruction of the superficial MCL and POL with an Achilles allograft in young, active patients with medial-sided knee injuries after total knee arthroplasty.

Surgical repair for deformities of the nail unit.

The nail apparatus is the largest and most complex skin appendage. Defects in this unit can result in significant functional insufficiency and cosmetic disfigurement. Common nail deformities include split nail, short nail, onycholysis, nail malalignment, hooked nail, and absent nail. Currently, surgical repair is the primary treatment for such deformities. Based on the etiological and anatomical classifications, one or more appropriate operations can be selected to repair nail unit deformities. These include autologous fat grafting, longitudinal cicatrectomy, Z-plasties, nail bed elongation, split-thickness sterile matrix grafting, volar V-Y advanced flap reconstruction, sterile matrix particle grafting, germinal matrix flaps, and germinal matrix grafting. This review discusses the fundamental classification of nail unit deformities, common reconstructive surgical techniques, and their features.

Efficacy of the Mercedes-Benz closure technique for vaginal reconstruction in female robot-assisted radical cystectomy.

Vaginal reconstruction using the posterior vaginal wall is required following radical cystectomy in women with resection of the uterus, adnexa, and anterior vaginal wall. Roll closure and clamshell closure are two widely known techniques. Of these, clamshell closure is recommended because roll closure has a high likelihood of breakdown or a resultant canal that is too narrow for sexual intercourse. In clamshell closure, however, folding the posterior vaginal wall anteriorly can be difficult. Therefore, we devised Mercedes-Benz closure, in which the vaginal wall is sutured from three directions to form a Mercedes-Benz shape, for anastomosis without tension on the vaginal wall. The present study was performed to investigate the efficacy of this alternative surgical technique for vaginal reconstruction. Twenty-six patients who underwent vaginal reconstruction following robot-assisted radical cystectomy were divided into two groups: 15 underwent clamshell closure and 11 underwent Mercedes-Benz closure. The patients' characteristics and surgical outcomes were compared between the two groups. There were no significant differences in clinical characteristics, including age, body mass index, and prior abdominal surgery between the two groups. The median vaginal reconstruction time tended to be longer in the Mercedes-Benz closure group than in the clamshell closure group (35.0 vs. 27.0 min, p=0.102). No complications associated with vaginal reconstruction were identified. The surgical outcomes were comparable between Mercedes-Benz closure and clamshell closure. If vaginal reconstruction with clamshell closure is difficult, Mercedes-Benz closure is a valuable alternative technique.

Severely resorbed mandible treatment: a 12-years follow-up case report

Rehabilitation of severely atrophic jaws has been a major problem for elderly patients and dentists. When conventional rehabilitation treatments are not possible, bone intervention is deemed necessary. Mandibles with less than 12 millimeters (mm) in height imply insufficient retention of the prosthesis, intolerance to mucosal load, pain and, consequently, incapacity of oral functions and decreased facial aesthetics. Endosseous implants are a widely accepted therapy for SRM rehabilitation, but it depends on the amount of bone available for a good prognosis. The Tent Pole technique is based on the addition of bone graft and expansion of the soft tissue matrix, mainly for cases of SRM with 6 mm or less of bone height available for rehabilitative treatments with endosseous dental implants. The objective of this report is to present and update a previously published clinical case of SRM reconstruction and rehabilitation using the tent pole technique, with 12 years of follow-up. The female patient, who underwent treatment at 63 years of age, received treatment using the Tent Pole surgical technique for mandibular reconstruction with cranial autogenous particulate bone graft. The treatment was favorable during the 12 years of control, the CT scan showed that the grafted bone was stable in volume and the mandible was enlarged in three dimensions.

Differences and surgical techniques of medial patellofemoral ligament reconstruction in children and adolescents patients

Differences and surgical techniques of medial patellofemoral ligament reconstruction in children and adolescents patients

Postoperative complications following ACL reconstruction: Prevention and management

This article aims to conduct a literature analysis on the current care and prevention strategies for postoperative problems following the repair of the anterior cruciate ligament (ACL). A presentation will be given on current trends in rehabilitation procedures, suggestions for interventions, and anticipated milestones in the healing process after ACL surgery. In recent years, protocols for ACL repair have progressed to a criterion-based progression rather than a tissue healing time frame. Because of advancements in ACL surgical reconstruction techniques and rehabilitation protocols, the danger of postoperative complications can manifest itself at any point during the recovery process. This includes both the beginning and the end of the process. In this paper, we will examine the significance of preventative measures for postoperative patient who has undergone ACL repair. Infection and loss of knee motion and strength are short-term complications that can occur after an ACL reconstruction. Long-term complications can include a secondary ACL injury to either the involved knee or the contralateral knee and the inability to return to high-level sports after this procedure. The multifaceted causes of secondary ACL injuries and the limited capacity of patients to return to high-level activities should continue to be the focus of future research.

Skeletal metastatic disease of the acetabulum: historical and evolving techniques for management.

The skeleton is the third most common organ system to be involved in the spread of metastatic carcinomas. More options for systemic therapies, surgeries and adjuvant treatments are providing longer survival for patients with known metastatic carcinoma to the bone. This means more patients are living with metastatic skeletal disease than ever before. If metastatic disease results in enough bone loss it can cause significant pain and dysfunction for patients. The acetabulum and pelvis are common sites of metastatic disease. The complex anatomy of the bony pelvis and acetabulum, as well as its proximity to important neurovascular and pelvic structures, can make surgical management of acetabular metastatic disease technically difficult. Decision making for patients with symptomatic skeletal metastatic disease is complex, and multidisciplinary teams can be helpful in providing appropriate care for these patients. Systemic chemotherapies, immunotherapies or targeted therapies may not adequately treat large areas of metastatic disease in the hip and pelvis. Radiation therapy is not successful for all patients. Fortunately, there are evolving therapies that are giving patients and providers more options for treatment. This review article will cover some of those new therapies and their outcomes, focusing on newer ablative, minimally invasive and surgical reconstruction techniques for metastatic disease involving the acetabulum. Decision making in the management of a patient's metastatic acetabular disease is still made on a case by case basis. This review article hopefully will remind clinicians of the variety of treatments available to these patients.

Hybrid Breast Reconstruction Following Mastectomy

The challenge following mastectomy is to safely reconstruct breasts of adequate size, shape, symmetry, softness, and sensation ("6 S"). Historically, patients have been offered two reconstructive modalities, namely either implant-based or autologous reconstruction. While this binary approach is appropriate for most patients, there remain a subset of patients for whom this simplistic approach is not suitable. For these, hybrid reconstruction, i. e., the combination of an implant with microsurgical tissue transfer, offers the possibility of individualised reconstruction, which avoids some of the limitations of traditional approaches. Hybrid breast reconstruction, thus expands the indications for microsurgical reconstruction and offers the advantages of this reconstructive modality to a larger patient population. In this article, the surgical technique of hybrid breast reconstruction is described, along with a discussion of important parameters related to this reconstructive modality, including plane and timing of implant placement, and the issue of radiotherapy.

A Novel Surgical Reconstruction Technique in the Management of Chronic Ulnar Collateral Ligament Tears with Volar Subluxation.

We hypothesized that ulnar collateral ligament reconstruction is inadequate for metacarpo- phalangeal joint stabilization in chronic ulnar collateral ligament injuries with volar subluxation due to dor- sal joint capsule injury. We consecutively performed both ulnar collateral ligament and dorsal joint capsule reconstruction to treat patients with a chronic ulnar collateral ligament tear with volar subluxation. This study aimed to present our preliminary results and experience with this technique in managing such cases. In this retrospective study, 7 patients (6 males, 1 female) who underwent surgical reconstruction of both ulnar collateral ligament and dorsal joint capsule reconstruction for the treatment of chronic ulnar collateral ligament injuries with volar subluxation were included. The mean age was 31 (range = 20-39) years, and the mean follow-up was 15.5 (range = 12-20) months. Several clinical and radio- logical data were recorded. The mean Visual Analogue Scale score significantly improved from 5.7 (range=5-8) to 0.57 (range=0-1) (P < .001). The mean quick- Disabilities of the Arm, Shoulder and Hand was significantly improved from 31.8 (range = 27.3-38.6) preoperatively to 3.2 (range = 0-6.8) at the final follow-up (P < .001). The mean preoperative extension deficit decreased from 18.5° (range = 10°-25°) to 0° (range= 0°-0°) at the final follow-up (P = .022). The mean preoperative flexion deficit increased from 10.7° (range = 0°-20°) to 31.4° (range=25°-35°) postoperatively (P=0.034). The mean key-pinch strength significantly increased from 33.2% (range=27-37) preoperatively to 10.2% (range=6-14) at the final follow-up assessment (P < .001). The mean hand grip strength significantly increased from 18.8% (range=15-23) preoperatively to 6.4% (range = 6-14) at the final follow-up assessment (P < .001). With encouraging short-term clinical outcomes and a lower complication rate, surgical recon- struction of both ulnar collateral ligament and dorsal joint capsule seems to be a safe and effective surgical technique in the management of chronic ulnar collateral ligament tears with volar subluxation.

Open Ankle Reconstruction of Lateral Ligaments (O-Anti-RoLL)

Ankle instability is a disabling condition that severely affects people’s quality of life. Nonoperative options have been suggested however a surgical procedure is often required to improve symptomatology and function of the ankle joint. In the current paper we describe a surgical technique of an open ankle reconstruction of the lateral ligaments (O-Anti-RoLL), which is a simple and safe surgical technique that utilizes an anatomic Y-graft. Level of Evidence: Diagnostic Level V. Expert opinion. See Instructions for Authors for a complete description of levels of evidence.

Spinal exposure for anterior lumbar interbody fusion (ALIF) in the lateral decubitus position: anatomical and technical considerations.

Single position surgery has demonstrated to reduce hospital length of stay, operative times, blood loss, postoperative pain, ileus, and complications. ALIF and LLIF surgeries offer advantages of placing large interbody devices under direct compression and can be performed by a minimally invasive approach in the lateral position. Furthermore, simultaneous access to the anterior and posterior column is possible in the lateral position without the need for patient repositioning. The purpose of this study is to outline the anatomical and technical considerations for performing anterior lumbar interbody fusion (ALIF) in the lateral decubitus position. Surgical technique and technical considerations for reconstruction of the anterior column in the lateral position by ALIF at the L4-5 and L5-S1 levels. Topics outlined in this review include: Operating room layout and patient positioning; surgical anatomy and approach; vessel mobilization and retractor placement for L4-5 and L5-S1 lateral ALIF exposure, in addition to comparative technique of disc space preparation, trialing and implant placement compared to the supine ALIF procedure. Anterior exposure performed in the lateral decubitus position allows safe-, minimally invasive access and implant placement in ALIF. The approach requires less peritoneal and vessel retraction than in a supine position, in addition to allowing simultaneous access to the anterior and posterior columns when performing 360° Anterior-Posterior fusion.

Cholesteatoma: Influence of surgical technique and EAONO/JOS stage on audiological results

Introduction and objectiveThe treatment of cholesteatoma is surgical in most cases. When it is indicated, it is preferable to choose a reconstructive surgical technique with the dual purpose of eradicating the disease and preserving or improving the patient’s hearing. In 2017, the European Academy of Otology and Neuro-Otology/Japanese Otological Society (EAONO/JOS) published a new cholesteatoma classification. The aims of this study were to determine the influence of the surgical technique used and this classification on patient’s hearing outcomes. MethodsA retrospective study that included patients who underwent reconstructive surgery of cholesteatoma between 2012 and 2017 was carried out. Based on pre-surgical computed tomography (CT) images, disease was staged according to the EAONO/JOS classification. Hearing outcomes obtained by pre and postoperative pure tone audiometry were analysed according to the surgical technique used and according to the stage of the disease. Results143 patients with no statistically significant differences in hearing thresholds before surgery were included. One year after surgery, all the patients’ (P = .01 and P = .001) airpure tone average (PTA) and mean differential auditory threshold had improved significantly. Those patients who underwent tympanoplasty with two-stage canal wall up mastoidectomy presented better postsurgical air PTA and postsurgical mean differential auditory threshold outcomes (P = .007 and P = .014) than those patients who underwent tympanoplasty with canal wall down mastoidectomy. Moreover, the patients who underwent tympanoplasty with two-stage canal wall up mastoidectomy had improved air PTA and mean differential auditory threshold one year after the surgery with statistical significance (P = .001, P = .013). The mean differential auditory threshold was also better (P = .008) in the patients who underwent tympanoplasty with canal wall down mastoidectomy one year after the procedure. ConclusionsReconstructive surgical techniques improve hearing one year after surgery. In our study, this improvement was significantly greater with tympanoplasty with two-stage canal wall up mastoidectomy.

Creating a Single Inflow Orifice From Living Donor Kidney Allografts With Multiple Renal Arteries.

Background: Multiple renal arteries (MRA) are often encountered during living-donor kidney transplantation (LDKT), requiring surgeons to pursue complex renovascular reconstructions prior to graft implantation. With improvements in reconstruction and anastomosis techniques, allografts with MRA can be successfully transplanted with similar outcomes to allografts with a single renal artery. Here, we describe in detail various surgical techniques for reconstruction of MRA grafts with the intent of creating a single arterial inflow. Methods: We retrospectively reviewed the medical records of all LDKT recipients with laparoscopically procured MRA kidneys between March 2008 and July 2021. Recipient and donor characteristics, operative data, type of reconstruction, and recipient outcomes were analyzed. The primary outcomes were the incidence of developing delayed graft function (DGF) and/or a vascular or urological complication within 12 months post-transplant. Results: Seventy-three LDKT recipients of MRA donor allografts were evaluated. Two renal arteries (RA) were encountered in 62 allografts (84.9%) and three RA in 11 allografts (15.1%). Renal artery reconstruction was performed in 95.8% (70/73) of patients. Eighteen different reconstruction techniques of MRA were utilized, the most common being side-to-side anastomosis in allografts with two RA (N = 44) and side-to-side-to-side anastomosis in allografts with three RA (N = 4). Interposition grafting was performed in seven cases (9.6%). A single ostium was created in 69 cases (94.5%), and the median warm ischemia time was 27 (range 20–42) minutes. None of the patients developed DGF or post-operative vascular or urological complications. Median creatinine at 3, 6, and 12 months post-transplant remained stable at 1.1 mg/dl. With a median follow-up of 30.4 months post-transplant, only one graft failure has been observed–death-censored graft survival was 98.6%. Conclusion: Complex reconstruction techniques to create a single renal artery ostium for graft implantation anastomosis in allografts with MRA show acceptable warm ischemic times, with no increased risk of post-operative vascular or urological complications.

Reconstruction of Paprosky Type III Acetabular Defects by Three-Dimensional Printed Porous Augment: Techniques and Clinical Outcomes of 18 Consecutive Cases.

ObjectiveTo introduce the surgical technique of reconstruction of Paprosky type III acetabular defects by 3D printed porous augments.MethodsFirst, CT scans of pelvis were obtained to establish the 3D reconstruction model of 3D printed porous augment. Then, a nylon pelvis model was printed to simulate operation with the surgeons. At this time, the augment was designed and modified according to the surgeon's suggestions and the 3D printing principles. Eighteen patients with Paprosky type III acetabular defects receiving reconstructive surgery by 3D printed porous augments were included in current study. Their data, including general information, intra‐operative findings, imaging results, functional scores, and complications were retrospectively analyzed.ResultsThe mean follow‐up time lasted 33.3 ± 2.0 (24–56) months. The average limb‐length discrepancy (LLD) was 31.7 ± 4.2 (3–59) mm preoperatively, 7.7 ± 1.4 (1–21) mm postoperatively (P < 0.0001), and 7.5 ± 1.2 (0–18) mm at the latest follow‐up. The mean vertical position of hip center of rotation (HCOR) from the interteardrop line changed from preoperative 50.7 ± 3.9 (23.3–75.3) mm to postoperative 22.9 ± 1.9 (10.1–40.3) mm (P < 0.0001), with the latest follow‐up revealing an HCOR of 22.3 ± 1.7 (11.0–40.5) mm. Follow‐up study showed that no hip had radiolucencies and radiological loosening of the acetabular components and augment. The average Harris hip score (HHS) improved from 40.3 ± 4.5 (10.5–71) before operation to 88.4 ± 1.9 (75–97) at the last follow‐up (P < 0.0001). Moreover, follow‐up exhibited that no periprosthetic joint infection, hip dislocation, fracture, and re‐revision occurred.ConclusionSurgical treatment of Paprosky type III acetabular defect with 3D printed porous augment was simple, achieved good match between porous augment and the defect bone surface and the acetabular component, ideally restored LLD and HCOR after operation, significantly improved HHS and attained good early clinical outcomes. It is a promising personalized solution for patients with severe acetabular bone defect.

Retention in maxillofacial prostheses

Facial disfigurement affects the functional, social and psychological well-being of an individual.&#x0D; It reduces an individual’s self esteem and acceptance in the society. It can be congenital or acquired. Prosthetic rehabilitation and surgical reconstruction techniques are the ways to lessen or diminish the problems associated with facial disfigurement. Prosthetic rehabilitation is favored as it is less invasive and affordable. The success of a prosthetic rehabilitation of any part relies on the availability of a method of attaching the artificial substitute securely to its place. Various means of retention have been developed over the years from metal bands to implants. With the advancing technology, in cases where anatomic undercuts are futile, craniofacial implants prove to be a boon for rehabilitation. In this literature review, the various modes of retention available for maxillofacial prostheses were assessed and appraised.

Are preoperative CT variables associated with the success or failure of subsequent ventral hernia repair: nested case-control study

ObjectivesSystematic review of CT measurements to predict the success or failure of subsequent ventral hernia repair has found limited data available in the indexed literature. To rectify this, we investigated multiple preoperative CT metrics to identify if any were associated with postoperative reherniation.MethodsFollowing ethical permission, we identified patients who had undergone ventral hernia repair and had preoperative CT scanning available. Two radiologists made multiple measurements of the hernia and abdominal musculature from these scans, including loss of domain. Patients were divided subsequently into two groups, defined by hernia recurrence at 1-year subsequent to surgery. Hypothesis testing investigated any differences between CT measurements from each group.ResultsOne hundred eighty-eight patients (95 male) were identified, 34 (18%) whose hernia had recurred by 1-year. Only three of 34 CT measurements were significantly different when patients whose hernia had recurred were compared to those who had not; these significant findings were assumed contingent on multiple testing. In particular, preoperative hernia volume (recurrence 155.3 cc [IQR 355.65] vs. no recurrence 78.2 [IQR 303.52], p = 0.26) nor loss of domain, whether calculated using the Tanaka (recurrence 0.02 [0.04] vs. no recurrence 0.009 [0.04], p = 0.33) or Sabbagh (recurrence 0.019 [0.05] vs. no recurrence 0.009 [0.04], p = 0.25) methods, differed between significantly between groups.ConclusionsPreoperative CT measurements of ventral hernia morphology, including loss of domain, appear unrelated to postoperative recurrence. It is likely that the importance of such measurements to predict recurrence is outweighed by other patient factors and surgical reconstruction technique.Key Points• Preoperative CT scanning is often performed for ventral hernia but systematic review revealed little data regarding whether CT variables predict postoperative reherniation.• We found that the large majority of CT measurements, including loss of domain, did not differ significantly between patients whose hernia did and did not recur.• It is likely that the importance of CT measurements to predict recurrence is outweighed by other patient factors and surgical reconstruction technique.

Mid-term outcomes of hemipelvic allograft reconstruction after pelvic bone tumor resections.

Objectives This study aims to evaluate survival of patients and implants, functions, and morbidity of surgical technique of reconstruction with a fresh-frozen massive pelvic allograft following a pelvic resection.Patients and methods Between January 2009 and December 2016, a total of 19 patients (12 males, 7 females; mean age: 35.8±14.4 years; range, 10 to 53 years) who underwent reconstruction with fresh-frozen massive allograft after internal hemipelvectomy were retrospectively analyzed. Patients̓ age, sex, resection types, histopathology and grades, surgical margins, operative times, intraoperative blood loss, complications experienced during their treatment (infection, dislocation, implant failure, nonunion, local recurrence and metastasis), neoadjuvant and adjuvant therapies they received, and functional scores were revelaed and analyzed in 10 years period.Results According to the Enneking and Dunham classification, two (10%) patients had type I resection only, six (32%) had type I-II, one (5%) had a type II resection, one (5%) had type II-III resection, three (16%) had type I-II-III resection, one (5%) had type I-IV resection, and five (26%) had type I-II-IV resection. The resection involved the acetabulum (type II) in all, but three patients. Several complications were seen in 12 patients, although seven patients had no complication. Pelvic resections had a high mortality rate in patients with malignant tumors and reconstruction with massive allograft had a high morbidity rate with susceptibility to many complications. Prolonged surgical time was found to be directly related to blood loss. Deep infection significantly worsened functional results.Conclusion Despite the high complication rates seen in pelvic resections, massive pelvic allografts represent a valid option for reconstruction after resection of pelvic tumors, but due to the associated morbidity, patients should be carefully selected.

Adjustable-loop cortical suspension device for posterolateral corner reconstruction in the setting of fibular avulsion fracture: a case series and novel technique description.

A novel technique using an adjustable-loop cortical suspension toggle device for reduction of a fibular head avulsion fracture (arcuate fracture) in posterolateral corner (PLC) reconstruction is described. Results of clinical follow-up are presented. 9 patients were retrospectively identified who underwent posterolateral corner reconstruction using an adjustable-loop cortical suspension toggle device. Radiographic examination was used to evaluate the successful healing of the avulsed fibular head fragments post-operatively. 7 patients reported satisfactory results with their clinical outcome with no feelings of knee instability or objective instability on exam at final follow-up. Post-operative radiographs obtained > 6months following reconstruction demonstrated well reduced and healed fracture in 5 of 6 patients, with 1 patient demonstrating maintained reduction but incomplete fracture union at 6months. This novel surgical technique for PLC reconstruction with an avulsed fibular head fracture is a viable alternative to previously described methods. The majority of patients report subjective satisfaction with a stable knee post-operatively. IV.

Abductor Tear in Total Hip Arthroplasty: A Scoping Literature Review

Background: Tear of the abductor mechanism is a well-known problem. Most of the published studies in that regard comes from the sport literature but little have been published about it in the THA settings. Abductor mechanism plays a crucial part in hip stability and limb gait hence an injury to it can lead to pain, weakness, and instability after THA. Objective: To review all studies reporting on abductor tear or insufficiency in Total Hip Arthroplasty and present the current state of literature on that. Methods: The Author completed an electronic database search of PubMed, EMBASE and PubMed Central to identify any studies reporting on Abductor mechanism and Total Hip Arthroplasty from the date of inception of the databases until August 2018. The author followed the PRISMA guidelines. The author extracted and summarized data from the identified studies. Only Studies published in the English literature and reported data on Abductor mechanism tear with THA were included. Results: 566 studies were identified. 32 studies met the inclusion criteria and were included in this review. Tear of hip abductor in THA were reported to be between 11-25%. It was more prevalent in women, older age population with no association to comorbidities. There is no clear evidence that the incidence of abductor weakness is higher in lateral than posterior approaches, contrary to the popular opinion. Surgical reconstruction techniques for chronic abductor insufficiency showed good results in the short-term regarding pain and function. Conclusions: Abductor mechanism tear after THA is a known complication that should be considered in patients with substantial lateral hip pain, limb and weak abduction following THA. Repair of the abductors can improve pain, function, and limb in three fourth of the patients specially if identified and repaired early. Promising results have been published for abductor reconstruction procedures for recurrent or chronic tears in short term follow-ups but still lack the long-term results.