title: Hip resurfacing using a modified lateral approach with limited splitting of the gluteus medius muscle results in significant impairment of hip abductor strength.
abstract: BACKGROUND
  A lateral, transgluteal approach for hip resurfacing carries the risk of approach-related weakening of the hip abductors due to unsuccessful re-adaptation of the gluteal muscles to the greater trochanter or to injury to the inferior nerve branch of the superior gluteal nerve.
  
  
  OBJECTIVE
  We investigated whether hip resurfacing using a soft tissue-sparing, modified transgluteal approach with limited cranial splitting of the gluteus medius muscle reduces hip abductor strength and the risk of approach-related injury to the superior gluteal nerve.
  
  
  METHODS
  Thirty-one patients (14 female, 17 male; mean age 53.5 ± 5.2 years) underwent hip resurfacing using a modified transgluteal approach with limited cranial splitting of the gluteus medius muscle. Nerve conduction signals were measured by surface electromyography (EMG), hip abductor strength by isokinetic testing a mean 36.2 months (± 11 mos) after surgery. The unoperated side was used as control.
  
  
  RESULTS
  Surface EMG disclosed no neural lesions of the inferior branch of the superior gluteal nerve. Isokinetics revealed a significant reduction in muscle strength on the operated versus the contralateral side.
  
  
  CONCLUSIONS
  Even a limited incision of the gluteus medius muscle resulted in significant impairment of hip abductor strength 2.5 years after surgery.
authors.affiliation: Department for Orthopaedic und Trauma Surgery, Alexianer Krankenhaus Krefeld GmbH-Krankenhaus Maria Hilf, Krefeld, Germany.
authors.forename: A J
authors.initials: AJ
authors.lastname: Moussazadeh
authors.forename: H
authors.initials: H
authors.lastname: Kohlhof
authors.forename: D C
authors.initials: DC
authors.lastname: Wirtz
authors.forename: M D
authors.initials: MD
authors.lastname: Wimmer
authors.forename: T M
authors.initials: TM
authors.lastname: Randau
authors.forename: T
authors.initials: T
authors.lastname: Wölk
authors.forename: S
authors.initials: S
authors.lastname: Gravius
mesh_terms: D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D002081:Buttocks / Q000601:surgery; D004576:Electromyography / Q000379:methods; D005260:Female; D005270:Femur Head / Q000601:surgery; D005272:Femur Neck / Q000601:surgery; D006621:Hip Joint / Q000503:physiopathology; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged
keywords: Hip resurfacing; isokinetics; lateral approach; surface EMG