title: Reconstruction of chronic abductor deficiency after revision hip arthroplasty using an extensor mechanism allograft.
abstract: This study reports the clinical outcome of reconstruction of deficient abductor muscles following revision total hip arthroplasty (THA), using a fresh-frozen allograft of the extensor mechanism of the knee. A retrospective analysis was conducted of 11 consecutive patients with a severe limp because of abductor deficiency which was confirmed on MRI scans. The mean age of the patients (three men and eight women) was 66.7 years (52 to 84), with a mean follow-up of 33 months (24 to 41). Following surgery, two patients had no limp, seven had a mild limp, and two had a persistent severe limp (p = 0.004). The mean power of the abductors improved on the Medical Research Council scale from 2.15 to 3.8 (p < 0.001). Pre-operatively, all patients required a stick or walking frame; post-operatively, four patients were able to walk without an aid. Overall, nine patients had severe or moderate pain pre-operatively; ten patients had no or mild pain post-operatively. At final review, the Harris hip score was good in five patients, fair in two and poor in four. We conclude that using an extensor mechanism allograft is relatively effective in the treatment of chronic abductor deficiency of the hip after THA when techniques such as local tissue transfer are not possible. Longer-term follow-up is necessary before the technique can be broadly applied.
authors.affiliation: Mount Sinai Hospital, 600 University Avenue, Toronto, Ontario, M5G 1X5, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Drexler
authors.affiliation: Mount Sinai Hospital, 600 University Avenue, Toronto, Ontario, M5G 1X5, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Abolghasemian
authors.affiliation: Mount Sinai Hospital, 600 University Avenue, Toronto, Ontario, M5G 1X5, Canada.
authors.forename: P R
authors.initials: PR
authors.lastname: Kuzyk
authors.affiliation: Mount Sinai Hospital, 600 University Avenue, Toronto, Ontario, M5G 1X5, Canada.
authors.forename: T
authors.initials: T
authors.lastname: Dwyer
authors.affiliation: Mount Sinai Hospital, 600 University Avenue, Toronto, Ontario, M5G 1X5, Canada.
authors.forename: Y
authors.initials: Y
authors.lastname: Kosashvili
authors.affiliation: Mount Sinai Hospital, 600 University Avenue, Toronto, Ontario, M5G 1X5, Canada.
authors.forename: D
authors.initials: D
authors.lastname: Backstein
authors.affiliation: Mount Sinai Hospital, 600 University Avenue, Toronto, Ontario, M5G 1X5, Canada.
authors.forename: A E
authors.initials: AE
authors.lastname: Gross
authors.affiliation: Mount Sinai Hospital, 600 University Avenue, Toronto, Ontario, M5G 1X5, Canada.
authors.forename: O
authors.initials: O
authors.lastname: Safir
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D064591:Allografts; D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000637:transplantation*; D010147:Pain Measurement; D010149:Postoperative Pain; D011183:Postoperative Complications / Q000601:surgery*; D011788:Quality of Life; D019651:Plastic Surgery Procedures / Q000379:methods*; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Chronic Abductor Deficiency; Extensor Mechanism Allograft; Revision Hip Arthroplasty