Dataset Information

Endoscopic Transfer of Gluteus Maximus and Tensor Fascia Lata for Primary Hip Abductor Deficiency.

ABSTRACT: Complete avulsion of hip abductor muscles may cause severe gait dysfunction and pain. An open surgical procedure to transfer tendons of the gluteus maximus and the tensor fasciae latae to the greater trochanter to make up for the deficient hip abductor has been proposed. The purpose of this study was to describe an endoscopic procedure to transfer gluteus maximus and the tensor fasciae latae to the greater trochanter for hip abductor deficiency.

SUBMITTER: Thaunat M

PROVIDER: S-EPMC7528212 | biostudies-literature | 2020 Sep

REPOSITORIES: biostudies-literature

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Endoscopic Transfer of Gluteus Maximus and Tensor Fascia Lata for Primary Hip Abductor Deficiency.

Thaunat Mathieu M Roberts Timothy T Bah Aliou A Vieira Thais Dutra TD Haidar Ibrahim I Bauwens Paul Henri PH

Arthroscopy techniques 20200906 9

Complete avulsion of hip abductor muscles may cause severe gait dysfunction and pain. An open surgical procedure to transfer tendons of the gluteus maximus and the tensor fasciae latae to the greater trochanter to make up for the deficient hip abductor has been proposed. The purpose of this study was to describe an endoscopic procedure to transfer gluteus maximus and the tensor fasciae latae to the greater trochanter for hip abductor deficiency. ...[more]

PMID: 33024661

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Project description:Hip abductor deficiency resulting from gluteus medius and minimus pathology is increasingly recognized as a generator of lateral-sided hip pain. In the setting of a failed gluteus medius repair or in patients with irreparable tears, transfer of the anterior portion of the gluteus maximus muscle can be performed to treat gluteal abductor deficiency. The classic description of the gluteus maximus transfer technique relies solely on bone tunnel fixation. This article describes a reproducible technique that incorporates the addition of a distal row to the tendon transfer, which may improve fixation by both compressing the tendon transfer to the greater trochanter and providing improved biomechanical strength to the transfer. Technique Video Video 1 Gluteus maximus transfer for hip abductor deficiency. A surgical incision is placed over the femoral shaft and extended proximally and posteriorly toward the posterior superior iliac spine. Electrocautery is used to dissect down to the iliotibial tract. A Cobb elevator is used to lift the subcutaneous adipose tissue and identify the underlying fascial layer. Once developed, the iliotibial tract is split in the midline of the greater trochanter to establish the anterior edge. Next, the posterior aspect of the flap is planned using electrocautery to preliminarily identify the posterior edge of the gluteus maximus flap. A nonabsorbable braided suture is used to place a Krackow stitch in the distal portion of the flap. Scar tissue or prior suture must be removed to expose the greater trochanter, and a high-speed burr is used to decorticate the greater trochanter and create a bleeding footprint. A 2.6-mm drill is used to create 3 anterior and 3 posterior bone tunnels in the greater trochanter, and FiberWire sutures are placed through the muscle flap on the anterior and posterior edges and shuttled through the bone tunnels. A double-row repair is used, and 1 limb from each FiberWire suture is passed through a suture anchor. The holes for each anchor are drilled and then tapped distal to the vastus ridge.

Project description:BACKGROUND:The direct anterior approach for total hip arthroplasty (THA) has specific advantages, but injury to the tensor fasciae lata muscle (TFLM) remains a concern. This injury in part negates some of the advantages of the intermuscular approach, because injury of the muscle fibers of the TFLM can lead to less satisfactory clinical results. Thus, in this study, we propose an intraoperative method to protect the TFLM and demonstrate its feasibility. METHODS:Fifty-six patients undergoing THA by the direct anterior approach were divided randomly into two groups. In group A, the TFLM was protected by an autogenous tissue "pad" created from the anterior capsule of the joint which protect the TFLM from direct contact with the retractors. In group B, the operation was carried out with no protection of the TFLM except the attempt by the surgeons to consciously avoid injury of the TFLM. We evaluated magnitude of changes in the muscle cross-sectional area (MSCA) and fatty atrophy (FA) by magnetic resonance imaging. The differences in blood hemoglobin and serum levels of myoglobin, lactate dehydrogenase (LDH), and creatine phosphokinase (CPK) were compared at different time, postoperatively. The Harris hip score, postoperative drainage volume and visual analogue scores (VAS) were compared between the two groups. RESULTS:LDH, CPK and myoglobin in group B were significantly higher than group A at 8, 24, and 48 h after the surgery. (p < 0.05) Compared to the group A, the decrease of hemoglobin in group B displayed significantly at 24 and 48 h after surgery. (P < 0.05) The significantly increased MSCA and FA of TFLM were demonstrated in group B. The PDV and VAS in group B were significantly higher than group A. (P < 0.05) The Harris score in group A was significantly higher than group B (P < 0.05) one month after surgery, but there was no significant difference six months later. CONCLUSIONS:Using the anterior capsule of the hip joint as an autogenous, protective capsular tissue pad to limit the trauma to the TFLM during a direct anterior approach to THA is an effective method to protect the TFLM and improve the clinical effect. TRIAL REGISTRATION:ChiCTR: ChiCTR1900025173. Retrospectively registered August 15, 2019.

Dataset Information

Endoscopic Transfer of Gluteus Maximus and Tensor Fascia Lata for Primary Hip Abductor Deficiency.

Publications

Endoscopic Transfer of Gluteus Maximus and Tensor Fascia Lata for Primary Hip Abductor Deficiency.

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