title: Modified Mostardi approach with ultra-high-molecular-weight polyethylene tape for total hip arthroplasty provides a good rate of union of osteotomized fragments.
abstract: BACKGROUND
  A lateral approach is common in total hip arthroplasty because of the good exposure it provides and its low complication rates. However, a drawback of the procedure is that the abductor mechanism is damaged when the tendinous insertion of the abductor muscle is split. Here, we describe a wafer technique using ultra-high-molecular-weight polyethylene tape for promising reattachment of the abductor mechanism.
  
  
  METHODS
  We retrospectively evaluated 120 consecutive primary total hip arthroplasties performed using a modified Mostardi approach, which involved reattaching the trochanter using either a braided polyester suture (polyester suture group, n = 60) or ultra-high-molecular-weight polyethylene tape (UHMWPE tape group, n = 60). The osteotomized fragment was reattached by inducing bone-to-bone contact using 3-mm-wide tapes that were precisely tied with a double-loop sliding knot in conjunction with a cable gun tensioner. The abductor strength and radiographic union rate were postoperatively assessed at 4 weeks and 6 months, respectively.
  
  
  RESULTS
  A statistically significant lower incidence of nonunion and cutout was observed in the UHMWPE group (0 and 5.0 %, respectively) compared to the polyester suture group (8.3 and 15 %, respectively). No differences in abductor strength either preoperatively or at 4 weeks postoperatively were observed between the groups. In radiographically healed patients, abductor strength at 4 weeks post-surgery exceeded preoperative strength. The recovery rate of hip abductor strength was 109.9 ± 34.3 % in union patients and 92.9 ± 23.3 % in nonunion patients, which was statistically significant. The mean Japanese Orthopedic Association hip scores improved from 48.6 to 86.8 in union patients and from 50.3 to 85.9 in nonunion patients at 1 year postoperatively; however, this difference was not significant.
  
  
  CONCLUSIONS
  The modified Mostardi approach using ultra-high molecular weight polyethylene tape can promote successful union of the osteotomized fragment.
authors.affiliation: Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Shogoin, Kawahara-cho 54, Sakyo-Ku, Kyoto, 606-8507, Japan, ykuromd@kuhp.kyoto-u.ac.jp.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Kuroda
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Akiyama
authors.forename: Manabu
authors.initials: M
authors.lastname: Nankaku
authors.forename: Kazutaka
authors.initials: K
authors.lastname: So
authors.forename: Shuichi
authors.initials: S
authors.lastname: Matsuda
mesh_terms: D019644:Arthroplasty, Replacement, Hip / Q000295:instrumentation*; D004867:Equipment Design; D005260:Female; D005269:Femur / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000601:surgery*; D011095:Polyethylenes; D011183:Postoperative Complications / Q000517:prevention & control; D012189:Retrospective Studies; D053832:Surgical Tape; D016896:Treatment Outcome
chemical_list: D011095:Polyethylenes; C111601:ultra-high molecular weight polyethylene