Introduction

Avulsion of abductors from hip is a debilitating complication after total hip arthroplasty performed through a trans-gluteal approach. It results in intractable pain, Trendelenberg limp and instability of the hip.

Techniques described for repairing these abductor tears including direct trans osseous repairs, endoscopic repair techniques, Achilles tendon allograft, Gluteus Maximus and Vastus Lateralis muscle transfers. The aim of our study was to assess improvement in pain, limp and abductor strength in patients operated upon surgically for confirmed abductor avulsion using a modified trans osseous repair and augmentation of repair with a Graft Jacket allograft acellular human dermal matrix (Graft jacket; Wright Medical Technology, Arlington, TN).

Introduction

Obesity has been associated with higher complication rates and poorer outcomes following joint replacement surgery. Body mass index (BMI) is a simple index of body composition and forms part of preoperative assessment. It does not take into account the proportion of lean mass and body fat and can give a false impression of body composition in healthy manual workers. A more accurate measure of body composition is available using non-invasive bioimpedance methods. This study aims to identify whether BMI provides an accurate measure of body fat composition in patients awaiting lower limb arthroplasty surgery.

Aim and design: The Olympia prosthesis was designed to minimise the risk of cement mantle deficiency, seen with some straight stem designs. Initially six stem sizes were produced. The highly polished surface (Ra 10 nm) reduces tensile stresses and cement abrasion. The oval cross-section allows a metaphyseal rotation lock. The natural anteversion is cement mantle friendly. The absence of corners reduces the stress risers and the anatomic shape accommodates the abductor approach and MIS. A size 0 has been added to the range as have lateralised options.

Methods: The first 120 stems in 111 consecutive patients were studied prospectively and reviewed clinically and radiographically by an independent observer. All operations were carried out by the senior author (LJT) with the same team. Rigorous attention to detail was given to femoral preparation and cement technique.

Clinical Results: At a mean follow up 10 years 8 months, 92% of the patients had a Harris Hip score over 80. 97% of outcomes were classified as excellent or good on the Oxford Hip Score. At review the survival was 99.2% (one patient has been revised for non-union of a Vancouver type C peri-prosthetic fracture).

Radiographic Results: Radiographically no stems showed more than 5° varus/valgus angulation (no centraliser was used). In the lateral projection 76% were neutral and 21% posterior. All Gruen zones had an intact cement mantle and 100% of stems had Barrack A or B cement/bone interfaces. No sinkage has been identified on plain AP and lateral radiographs.

The Olympia has only been used at 3 centres until the 10 year clinical and radiographic results were available. The results at 10 years justify further evaluation. It is crucial that meticulous detail to cement technique is adhered to in the operative technique. The ease of insertion and natural anteversion has given confidence to surgeons in training.