Hip resurfacing using a modified lateral approach with limited splitting of the gluteus medius muscle results in significant impairment of hip abductor strength

Article type: Research Article

Authors: Moussazadeh, A.J.^a | Kohlhof, H.^b | Wirtz, D.C.^b | Wimmer, M.D.^b | Randau, T.M.^b | Wölk, T.^c | Gravius, S.^{b; *}

Affiliations: [a] Department for Orthopaedic und Trauma Surgery, Alexianer Krankenhaus Krefeld GmbH-Krankenhaus Maria Hilf, Krefeld, Germany | [b] Department for Orthopaedic und Trauma Surgery, Rheinische Friedrich-Wilhelms-University, Bonn, Germany | [c] Department for Orthopaedic und Trauma Surgery, Gemeinschaftskrankenhaus Mayen-Koblenz, Kemperhof Koblenz, Germany

Correspondence: [*] Corresponding author: Sascha Gravius, Department for Orthopaedic und Trauma Surgery, Rheinische Friedrich-Wilhelms-Universität Bonn, Sigmund-Freud-Strasse 25, 53105 Bonn, Germany. Tel.: +49 228 287 14170; Fax: +49 228 287 14175; E-mail: [email protected].

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.

Keywords: Hip resurfacing, lateral approach, surface EMG, isokinetics

DOI: 10.3233/THC-130745

Journal: Technology and Health Care, vol. 21, no. 5, pp. 501-510, 2013