Significant muscle damage after multiple revision total hip replacements through the direct lateral approach

Roth, Philipp von; Abdel, Matthew P.; Wauer, F.; Winkler, Tobias; Wassilew, Georgi I.; Diederichs, Gerd; Perka, Carsten

doi:10.1302/0301-620x.96b12.34256

Cited by 41 publications

(21 citation statements)

References 32 publications

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“…However, by three months this not statistically significant and did not correlate with Trendelenburg test. In revision THA, fatty degeneration of gluteus medius as assessed by MRI scan has been demonstrated when the direct lateral approach is employed (22). Whilst there was no direct correlation between the cumulative fatty degeneration and the presence of a Trendelenburg sign in the revision group, there was significantly more muscle trauma observed in the revision group than the primary group.…”

Section: Discussionmentioning

confidence: 99%

Posterior Approach to Optimise Patient-Reported Outcome from Revision Hip Arthroplasty

et al. 2016

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General rightsThis document is made available in accordance with publisher policies. Please cite only the published version using the reference above. Abstract IntroductionMost total hip arthroplasty (THA) in the UK are performed through a posterior or lateral surgical approach. We aimed to investigate any difference in outcome from revision THA according to the approach at primary and revision THA surgery.

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Section: Discussionmentioning

confidence: 99%

Posterior Approach to Optimise Patient-Reported Outcome from Revision Hip Arthroplasty

et al. 2016

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“…54,55 The gluteus minimus, gluteus medius, the abductor, and adductor muscle groups are affected the most by trauma due to THA. 51,56 Gradual muscle degeneration after the surgical procedure not only causes pain and irritation but also predisposes the patient to limping, hip dislocation, and re-injury. 57 It is pertinent to note that these iatrogenic injuries and consequential pathologies even occur after what is commonly considered as a successful primary or revision THA procedure.…”

Section: Surgical Treatmentmentioning

confidence: 99%

Cell therapy to improve regeneration of skeletal muscle injuries

Qazi

Duda

Ort

et al. 2019

J cachexia sarcopenia muscle

110

128

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Diseases that jeopardize the musculoskeletal system and cause chronic impairment are prevalent throughout the Western world. In Germany alone, ~1.8 million patients suffer from these diseases annually, and medical expenses have been reported to reach 34.2bn Euros. Although musculoskeletal disorders are seldom fatal, they compromise quality of life and diminish functional capacity. For example, musculoskeletal disorders incur an annual loss of over 0.8 million workforce years to the German economy. Among these diseases, traumatic skeletal muscle injuries are especially problematic because they can occur owing to a variety of causes and are very challenging to treat. In contrast to chronic muscle diseases such as dystrophy, sarcopenia, or cachexia, traumatic muscle injuries inflict damage to localized muscle groups. Although minor muscle trauma heals without severe consequences, no reliable clinical strategy exists to prevent excessive fibrosis or fatty degeneration, both of which occur after severe traumatic injury and contribute to muscle degeneration and dysfunction. Of the many proposed strategies, cell‐based approaches have shown the most promising results in numerous pre‐clinical studies and have demonstrated success in the handful of clinical trials performed so far. A number of myogenic and non‐myogenic cell types benefit muscle healing, either by directly participating in new tissue formation or by stimulating the endogenous processes of muscle repair. These cell types operate via distinct modes of action, and they demonstrate varying levels of feasibility for muscle regeneration depending, to an extent, on the muscle injury model used. While in some models the injury naturally resolves over time, other models have been developed to recapitulate the peculiarities of real‐life injuries and therefore mimic the structural and functional impairment observed in humans. Existing limitations of cell therapy approaches include issues related to autologous harvesting, expansion and sorting protocols, optimal dosage, and viability after transplantation. Several clinical trials have been performed to treat skeletal muscle injuries using myogenic progenitor cells or multipotent stromal cells, with promising outcomes. Recent improvements in our understanding of cell behaviour and the mechanistic basis for their modes of action have led to a new paradigm in cell therapies where physical, chemical, and signalling cues presented through biomaterials can instruct cells and enhance their regenerative capacity. Altogether, these studies and experiences provide a positive outlook on future opportunities towards innovative cell‐based solutions for treating traumatic muscle injuries—a so far unmet clinical need.

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“…3 Revision arthroplasty using a lateral approach as described by Harding compromises the gluteus medius muscle and may be associated with poor postoperative function compared with the standard posterior approach. [21][22][23] Therefore, the posterior approach, originally described by Kocher and Langenbeck, remains the most versatile approach for both pelvic fractures and revision THA. 2,12 The standard approach to the acetabulum splitting the gluteus maximus muscle, as described by Kocher and Langenbeck, only provides limited exposure.…”

Section: Discussionmentioning

confidence: 99%

Access to the Ischium: A Simple Extension of the Posterior Approach in Revision Hip Arthroplasty

Boettner

Rüeckl

2018

J Hip Surg

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Reconstruction of acetabular defects in revision total hip arthroplasty (THA) requires excellent exposure. Most extensile approaches to the acetabulum were described in the trauma literature and are not beneficial for revision THA. This article describes a modification of the standard posterior surgical approach to improve visualization of the ischium as required for acetabular defect reconstruction, insertion of standard and custom triflange cages as well as posterior column plating. The current surgical technique utilizes an intermuscular plane between the gemellus inferior muscle and the obturator externus muscle. This intermuscular plane leads the surgeon directly to the ischium and facilitates easy extension toward the insertion of the hamstring muscles without compromising the insertion of the external rotator muscles along the ischium. This article describes a novel surgical approach to the posterior column and ischium under special consideration of the sciatic nerve, superior gluteal vessels, and medial femoral circumflex artery. This simple extension of the standard posterior approach optimizes exposure of the posterior column during revision THA using a posterior approach.

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Significant muscle damage after multiple revision total hip replacements through the direct lateral approach

Cited by 41 publications

References 32 publications

Posterior Approach to Optimise Patient-Reported Outcome from Revision Hip Arthroplasty

Posterior Approach to Optimise Patient-Reported Outcome from Revision Hip Arthroplasty

Cell therapy to improve regeneration of skeletal muscle injuries

Access to the Ischium: A Simple Extension of the Posterior Approach in Revision Hip Arthroplasty

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