title: Significant muscle damage after multiple revision total hip replacements through the direct lateral approach.
abstract: Intact abductors of the hip play a crucial role in preventing limping and are known to be damaged through the direct lateral approach. The extent of trauma to the abductors after revision total hip replacement (THR) is unknown. The aim of this prospective study was to compare the pre- and post-operative status of the gluteus medius muscle after revision THR. We prospectively compared changes in the muscle and limping in 30 patients who were awaiting aseptic revision THR and 15 patients undergoing primary THR. The direct lateral approach as described by Hardinge was used for all patients. MRI scans of the gluteus medius and functional analyses were recorded pre-operatively and six months post-operatively. The overall mean fatty degeneration of the gluteus medius increased from 35.8% (1.1 to 98.8) pre-operatively to 41% (1.5 to 99.8) after multiple revision THRs (p = 0.03). There was a similar pattern after primary THR, but with considerably less muscle damage (p = 0.001), indicating progressive muscle damage. Despite an increased incidence of a positive Trendelenburg sign following revision surgery (p = 0.03) there was no relationship between the cumulative fatty degeneration in the gluteus medius and a positive Trendelenburg sign (p = 0.26). The changes associated with other surgical approaches to the hip warrant investigation.
authors.affiliation: Charité Universitaetsmedizin , Center for Musculoskeletal Surgery, Department of Orthopedic Surgery, Charitéplatz 1, 10117 Berlin, Germany.
authors.forename: P
authors.initials: P
authors.lastname: von Roth
authors.affiliation: Mayo Clinic, Department of Orthopedic Surgery, 200 First Street SW, Rochester, Minnesota 55905, USA.
authors.forename: M P
authors.initials: MP
authors.lastname: Abdel
authors.affiliation: Charité Universitaetsmedizin , Center for Musculoskeletal Surgery, Department of Orthopedic Surgery, Charitéplatz 1, 10117 Berlin, Germany.
authors.forename: F
authors.initials: F
authors.lastname: Wauer
authors.affiliation: Charité Universitaetsmedizin , Center for Musculoskeletal Surgery, Department of Orthopedic Surgery, Charitéplatz 1, 10117 Berlin, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Winkler
authors.affiliation: Charité Universitaetsmedizin , Center for Musculoskeletal Surgery, Department of Orthopedic Surgery, Charitéplatz 1, 10117 Berlin, Germany.
authors.forename: G
authors.initials: G
authors.lastname: Wassilew
authors.affiliation: Charité Universitaetsmedizin , Center for Musculoskeletal Surgery, Department of Orthopedic Surgery, Charitéplatz 1, 10117 Berlin, Germany.
authors.forename: G
authors.initials: G
authors.lastname: Diederichs
authors.affiliation: Charité Universitaetsmedizin , Center for Musculoskeletal Surgery, Department of Orthopedic Surgery, Charitéplatz 1, 10117 Berlin, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Perka
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000379:methods*; D016022:Case-Control Studies; D005260:Female; D018475:Head-Down Tilt; D006615:Hip; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000473:pathology* / Q000503:physiopathology; D011446:Prospective Studies; D012086:Reoperation / Q000009:adverse effects
keywords: Direct lateral approach; Hip abductors; MRI; Magnet resonance imaging; Muscle trauma; Revision total hip arthroplasty; Total hip replacement