Sonographic Evaluation of the Abductor Mechanism After Total Hip Arthroplasty

Abstract

Objective. The purpose of this series was to determine the frequency of abductor mechanism avulsion by sonography after total hip arthroplasty with the Hardinge approach (J Bone Joint Surg Br 1982; 64:17-19) and its relationship to the presence of insufficiency of this musculature in the postoperative period. Methods. Thirty-four consecutive patients were prospectively accessed in the postoperative period of hip arthroplasty by the Trendelenburg test, hip sonography, and abductor muscle electromyography. In patients who were found to have clinical insufficiency of the abductor musculature, we also measured the femoral offset in the preoperative and postoperative radiographs. Hip sonography was performed by an experienced musculoskeletal radiologist blinded to the other tests, and the tendons of the gluteus medius and gluteus minimus were visualized on longitudinal and transverse sections with a 7-to 10-MHz linear transducer. Results. Eight patients presented clinical insufficiency of the abductor musculature as detected by the Trendelenburg test. Four of these 8 patients with abductor insufficiency presented tendinous avulsion detected by sonography. One of the 4 patients with abductor insufficiency and normal sonographic findings had a decrease in the femoral offset caused by the arthroplasty itself. Two patients presented electromyographic changes of the abductor musculature, with no tendinous avulsion detected by sonography and no abductor insufficiency. Conclusions. We concluded that in patients undergoing total hip arthroplasty by the Hardinge approach in whom insufficiency of the abductor musculature develops, sonography is an interesting method of investigation because it identified the cause of this problem in most of our patients.

Management of abductor mechanism deficiency following total hip replacement

“…Reduced offset after THR is a potential cause of hip abductor weakness. 26 Ultrasonography has not been extensively used in the diagnosis of this condition, but Garcia, Picado and Nogueira-Barbosa 27 noted an overall incidence of 20.6% of abductor tendon tears one year after THR using this technique. However, only 11.7% of their patients were clinically symptomatic and had a positive Trendelenburg test.…”

Ultrasound of the Postoperative Hip

“…Using the anterolateral approach, the middle of the gluteus medius muscle is split and the anterior tendinous portion along with the gluteus minimus tendon are released from the greater trochanter. 9,10 The tendon is then repaired following the placement of the hip joint prosthesis. One of the complications of the anterolateral approach is subsequent tearing of the repaired gluteus medius and minimus tendons.…”

“…Patients may then present with hip joint pain and limping, typically with a Trendelenburg gait (inability to abduct the hip against gravity). 10 Other causes of abnormal function of the abductor musculature after total hip replacement include injury to the superior gluteal nerve and biomechanical changes of loss of femoral offset. 10,11 The femoral offset is the horizontal distance measured from the center of rotation of the femoral head to the anatomical axis of the femur and corresponds to the lever arm of the abductor musculature to counterbalance the body weight and maintain a level pelvis during the gait cycle.…”

“…10,11 The femoral offset is the horizontal distance measured from the center of rotation of the femoral head to the anatomical axis of the femur and corresponds to the lever arm of the abductor musculature to counterbalance the body weight and maintain a level pelvis during the gait cycle. 10 The anatomy of the insertion of the gluteal musculature is complex. Pfirrmann and colleagues have described the main tendon of the gluteus medius inserting on the posterior superior aspect of the greater trochanter, a lateral part of the tendon insertion being obliquely orientated, extending from the posterior to the anterior greater trochanter (►Fig.…”

Common Sonographic Findings in the Painful Hip After Hip Arthroplasty

“…Sonography is an established modality for identifying and characterizing hip abductor tendon abnormalities in patients with and without hip replacement 53 – 55 . Gluteal tendinosis usually appears as tendon thickening and/or hypoechogenicity, and echogenic, punctuate, or coarse calcifications with or without acoustic shadowing may occur within the gluteal tendons as in other tendons in the body in cases of calcific tendinosis (hydroxyapatite deposition disease; Figure 11).…”