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Scientific Articles   |    
Repair of a Deficient Abductor Mechanism with Achilles Tendon Allograft After Total Hip Replacement
Michael N. Fehm, MD1; James I. Huddleston, MD2; Dennis W. Burke, MD1; Jeffrey A. Geller, MD3; Henrik Malchau, MD, PhD1
1 Harris Orthopaedic Laboratory and the Adult Reconstructive Unit, Department of Orthopaedic Surgery, Massachusetts General Hospital, Jackson Building 1126, 55 Fruit Street, Boston, MA 02114. E-mail address for H. Malchau: hmalchau@partners.org
2 Stanford University School of Medicine, 300 Pasteur Drive, Edwards R109, Stanford, CA 94305
3 Department of Orthopaedic Surgery, Columbia University Medical Center, 622 West 168th Street, New York, NY 10032
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Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity.

Investigation performed at the Harris Orthopaedic Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts

Copyright © 2010 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2010 Oct 06;92(13):2305-2311. doi: 10.2106/JBJS.I.01011
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Abstract

Background: 

Abductor mechanism insufficiency after total hip arthroplasty is a rare but debilitating problem. The diagnosis is difficult, and when the condition is recognized there are few successful treatment options. The purpose of this study was to review our experience with a surgical technique involving use of a fresh-frozen Achilles tendon allograft with an attached calcaneal bone graft to reconstruct a deficient abductor mechanism after total hip arthroplasty.

Methods: 

From 2003 to 2006, we performed seven abductor reconstructions with an Achilles tendon allograft in patients with abductor deficiency after total hip arthroplasty. At a mean of twenty-nine months after the total hip arthroplasty, all seven patients had symptoms of lateral hip pain and abductor muscle weakness as demonstrated by a Trendelenburg test. The abductor tendon rupture was diagnosed on the basis of an arthrogram and was confirmed at surgery.

Results: 

Before the reconstruction, the average Harris hip score was 34.7 points and the average pain score was 11.4 points. After a minimum duration of follow-up of twenty-four months, the average Harris hip score was 85.9 points and the average pain score was 38.9 points.

Conclusions: 

Abductor reconstruction with an Achilles tendon allograft with a calcaneal bone block attached to the greater trochanter can produce substantial relief of pain, increased abductor muscle strength, decreased limp, and improvements in the Trendelenburg sign and in function at the time of early follow-up.

Level of Evidence: 

Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

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    References

    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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