Abstract
Abductor deficiency after total hip arthroplasty is a severe complication with functional
limitations and a significant reduction in the patientʼs quality of life. Common causes
are degenerative ruptures or approach-related iatrogenic damage to the gluteus medius
and minimus muscle and the inferior gluteal nerve, fractures of the greater trochanter
and incorrect reconstruction of leg length and femoroacetabular offset. With a standardised
diagnosis consisting of a clinical examination, conventional X-ray and MRI, the causes
of the functional problems can often be reliably determined. Therapy of abductor deficiency
is challenging for both patients and physicians and is often tedious. However, with
a clear diagnostic and therapeutic algorithm and straightforward patient education,
good treatment results can be achieved even in this challenging condition. Conservative
therapy with eccentric stretching and muscle strengthening are the basis of the treatment.
In cases of
progression of complaints despite intensive conservative treatment, various anatomical
and extra-anatomical surgical reconstruction methods are available to relieve pain
and improve function. Anatomical reconstruction of the gluteal tendon insertion is
an option in cases of low-grade fatty infiltration and moderate retraction of the
gluteal muscles. In situations with advanced degenerative changes in the gluteus medius
and minimus muscles and an intact gluteus maximus muscle, transfer of the anterior
portion of the gluteus maximus according to Whiteside is an option. For high-grade
defects of the soft tissue, there is also the option of an isolated or combined transfer
of the vastus lateralis muscle.
Key words
hip abductor deficiency - total hip arthroplasty - muscle reconstruction
