O1333 REDUCED INCIDENCE OF ABDUCTOR DYSFUNCTION AFTER TOTAL HIP ARTHROPLASTY USING A MODIFIED DIRECT LATERAL APPROACH

Abstract

Aims: To compare incidence of abductor dysfunction using two direct lateral approaches, a more conventional approach and a new modified approach that reliably identifies and separately detaches gluteus minimus from the greater trochanter to allow its subsequent secure repair. Methods: We followed-up 73 patients who had undergone total hip arthroplasty by a single senior surgeon using one of two direct lateral approaches. With the more conventional approach (33 patients) medius and minimus were not reliable detached separately from the trochanter; minimus was either detached en mass with the anterior half of medius or detached during capsulotomy/capsulectomy. The new modified approach (40 patients), developed after careful study of the anatomy of the attachments of the glutei, involved division of the anterior half of medius leaving a 1 cm cuff of tissue attached to the trochanter and allowed reliable identification and separate detachment of minimus. Stay sutures were used in a novel way to achieve a more secure reattachment to try and reduce the risk of failure of the repair. Abductor function was assessed by Trendelenberg testing at 1-year post-arthroplasty. Results: The incidence of abductor dysfunction was 12% with the more conventional approach and 2.5% with the new modified approach. Conclusions: A significantly reduced incidence of abductor dysfunction occurred with our new modified approach and we believe this provides evidence for the importance of separate identification of gluteus minimus and its careful reattachment in ensuring good abductor function.