Arthrography for the diagnosis of abductor avulsion after total hip arthroplasty: A comparison of arthrographic and surgical findings in 33 patients

Abstract

Background Weakness of the abductor muscles-or even their avulsion-is a potential risk when total hip arthroplasty (THA) is performed using the anterolateral approach. Avulsion of the re-attached gluteus medius leads to a limp, but can also provide an open canal for joint fluid to escape to the trochanteric region. Thus, our hypothesis was that arthrography can be used to diagnose such detachment.Methods We compared THA arthrographies with peroperative findings retrospectively in 33 patients who had undergone surgical exploration for a muscle reattachment because of a strong suspicion of abductor avulsion at physical examination.Results After a mean follow-up time of 22 (2-57) months after THA, 14/33 patients had a positive (pathological) arthrogram whereas 19 had a negative (normal) result. All 14 patients with a positive arthrogram were verified to have an avulsion of the abductor muscle at the operation. 10 of the 19 patients with a negative arthrogram had an intact abductor insertion, but 9 had an avulsion. All of these 9 patients with the peroperatively disclosed avulsion had a fibrous capsule, which obstructed the fistula leading from the joint cavity to the trochanteric bursa region.Interpretation Arthrography is a valuable diagnostic aid in the evaluation of patients with abductor weakness and with Trendelenburg's gait appearing after a THA performed using the anterolateral approach. A positive finding helps in the operative decision making, but a negative arthrogram is not a reliable predictor.

Sonographic Evaluation of the Abductor Mechanism After Total Hip Arthroplasty

“…One of the potential complications of this approach is the avulsion of the repaired abductor mechanism, which may cause insufficiency of this musculature, limping, and pain. [2][3][4][5][6][7][8] Although this condition was described as early as 1989, 2 many orthopedists are not familiar with its existence and recognition. 9 Furthermore, most of the studies dealing with the insertion of the abductor musculature in the greater trochanter have used magnetic resonance examination as an imaging method, [10][11][12][13][14][15] whereas little has been published about sonography as an imaging method in the study of the integrity of the so-called hip rotator cuff 13,16 after total arthroplasty.…”

“…the use of radiographs with internal metal markers, 6 arthrography, 8 and magnetic resonance imaging. 15,23 Although sonography is a well-established method for the identification and characterization of tendinopathies of the hip rotator cuff, 24,25 little information is available concerning its use in the diagnosis of abductor avulsion after total hip arthroplasty.…”

Estudo da força abdutora do quadril após artroplastia total com o uso de sutura transóssea ou transtendínea na via de acesso lateral direta

“…Mesmo com a cuidadosa reinserção, pode haver insuficiência abdutora associada a esta via de acesso na ATQ, provocada por lesão do nervo glúteo superior ou a avulsão parcial ou completa da sutura do manguito muscular abdutor. (LÜBBEKE et al,2008;KIYAMA;NAITO;SHINODA;MAEYAMA, 2010;YLINEN et al, 2007;MIOZZARI et al, 2010;GARCIA; PICADO; NOGUEIRA-BARBOSA, 2010).…”

“…A deficiência da musculatura abdutora foi documentada em pacientes antes e depois da cirurgia de prótese total de quadril. (YLINEN et al ,2007;LÜBBEKE et al ,2008;WIDLER et al ,2009 ;MIOZZARI et al ,2010 ;GARCIA;PICADO;NOGUEIRA-BARBOSA, 2010) . Howell et al (2001) estudaram 176 pacientes consecutivos submetidos a ATQ, identificando 20% de prevalência de lesões no glúteo médio e mínimo previamente existentes.…”

“…O diagnóstico da avulsão da musculatura abdutora é em geral realizado pelo exame físico, sendo que a diminuição da força abdutora, somada à marcha em Trendelenburg, é altamente sugestivo de lesão (YLINEN et al, 2007 A força da musculatura abdutora do quadril pode ser medida com diferentes aparelhos e posições do corpo. Testes manuais, aparelhos isocinéticos e dinamômetros portáteis ou fixos já vem sendo usados com resultados satisfatórios.…”