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Achilles tendon allograft shows promise for repairing failed hip abductors post-THA
The technique resulted in less postoperative pain, more function and improved Harris Hip scores.
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VIENNA — For the rare occasions when a hip abductor muscle massively fails after total hip arthroplasty, a reconstruction method using Achilles tendon allograft may help resolve lateral hip pain and abductor weakness, according to early results.
Massive abductor failure following total hip arthroplasty (THA) has been notoriously difficult to manage. Henrik Malchau, MD, noted this new repair technique was effective.
“The Achilles tendon allografting with this method is promising,” he said at the 10th European Federation of National Associations of Orthopaedics and Traumatology (EFORT) Congress. “The Trendelenburg sign literally disappeared in all patients.”
Regenerative technique
From 2003 to 2006 surgeons at Massachusetts General Hospital in Boston used the technique to reconstruct hip abductor muscles in seven patients after primary THA. Five patients had hip arthrograms to confirm the diagnosis.
The technique involves passing freeze-dried Achilles tendon allograft with attached calcaneal bone through a tunnel in the greater trochanter. The bone pieces are fixed to the trochanter with bone cuts and grooves to lock them in place. The allograft’s soft tissue is sutured to the native tissue in the area to facilitate fibrous graft healing, he said.
Malchau recommended placing the hip in 15· abduction during the procedure.
Hip scores improve
Malchau said they initially thought the problem was due to abductor splitting in the anterolateral approach.
However, he explained the investigators diagnosed massive abductor loss in patients whose primary THAs were completed with posterior and anterolateral approaches.
Preoperatively, patients had average Harris Hip scores of 34.7 points and pain scores that were 11.4 points. Scores improved to 85.9 and 38.9 points, respectively, at 31 months.
Postoperatively, patients were braced for 6 weeks and were allowed partial or protected weight-bearing. Most patients used canes and walkers when their hip pain began to resolve and hip function improved.
For more information:
- Henrik Malchau, MD, can be reached at Massachusetts General Hospital, 55 Fruit St., GRJ 1126, Boston, MA 02114; 617-726-3866; e-mail: hmalchau@partners.org.
Reference:
- Fehm M, Burke D, Geller J, et al. Repair of massive abductor loss after total hip replacement using Achilles tendon allograft. Paper #F588. Presented at the 10th EFORT Congress. June 3-6, 2009. Vienna.