Surgery for Abductor Tears After Revision THA?

If a patient experiences an abductor mechanism lesion after revision total hip arthroplasty (rTHA), he or she can be left in pain and with impaired mobility. A team of researchers from Italy took it upon themselves to conduct a systematic review of all studies on the surgical treatment of these conditions following rTHA.

Their work, “Surgical repair for abductor lesion after revision total hip arthroplasty: a systematic review,” was published in the July 2020 edition of HIP International.

Alberto Di Martino, M.D., Ph.D., is an associate professor of orthopedic surgery at the University of Bologna 1st Orthopedic and Traumatolog Clinic, IRCCS – Istituto Ortopedico Rizzoli. Dr. Di Martino, also with the Sidney Kimmel Medical College of Thomas Jefferson University in Philadelphia, Pennsylvania, told OTW, “The idea to perform the study came from our clinical practice. We had to manage patients with adbuctor insufficiency after revision THA that were complaining of hip pain and limping, and we asked which was the best evidence on the topic. There was not a high evidence study available in literature; therefore, we tried to organize and summarize the available studies to support the work of colleagues worldwide.”

The researchers reviewed nine retrospective case series with a total of 92 patients.

“Several surgical strategies have been described and performed: a repair using a synthetic mesh was reported in 1 study; 2 studies reported on local muscle transfer (gluteus maximus transfer or advancement); vastus lateralis advancement was described in 4 studies while in 2 studies the injury was repaired with the use of an allograft,” wrote the authors. “Overall positive results have been reported in terms of pain reduction, while poor to mild functional scores with persistent limping have often been observed in the postoperative period.”

Pain Relief More Likely Than Functional Improvement

Dr. Di Martino told OTW, “We found that there are several surgical techniques available for reconstruction of the adductor mechanism of the hip. Despite unpredictable results on abductor function and limping, pain relief is likely to be obtained with reconstructive surgery.”

“In experienced hands, surgical treatment of symptomatic abductor tears after revision THA should be encouraged, even in the absence of actual implant failure. It might restore joint function, and improve pain and quality of life.”

“The impact of reconstructive surgery on the longevity of THA implants is still little explored. If this hypothesis would be confirmed, it might further support the indication to perform reconstructive surgery in these patients.”