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The Bone & Joint Journal
Vol. 96-B, Issue 12 | Pages 1618 - 1622
1 Dec 2014
von Roth P Abdel MP Wauer F Winkler T Wassilew G Diederichs G Perka C

Intact abductors of the hip play a crucial role in preventing limping and are known to be damaged through the direct lateral approach. The extent of trauma to the abductors after revision total hip replacement (THR) is unknown. The aim of this prospective study was to compare the pre- and post-operative status of the gluteus medius muscle after revision THR. We prospectively compared changes in the muscle and limping in 30 patients who were awaiting aseptic revision THR and 15 patients undergoing primary THR. The direct lateral approach as described by Hardinge was used for all patients. MRI scans of the gluteus medius and functional analyses were recorded pre-operatively and six months post-operatively. The overall mean fatty degeneration of the gluteus medius increased from 35.8% (1.1 to 98.8) pre-operatively to 41% (1.5 to 99.8) after multiple revision THRs (p = 0.03). There was a similar pattern after primary THR, but with considerably less muscle damage (p = 0.001), indicating progressive muscle damage. Despite an increased incidence of a positive Trendelenburg sign following revision surgery (p = 0.03) there was no relationship between the cumulative fatty degeneration in the gluteus medius and a positive Trendelenburg sign (p = 0.26). The changes associated with other surgical approaches to the hip warrant investigation.

Cite this article: Bone Joint J 2014;96-B:1618–22.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_14 | Pages 51 - 51
1 Mar 2013
Wassilew G Carsten P
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Purpose

Diagnosis of acetabular retroversion is essential in femoroacetabular impingement (FAI), but its assessment from radiographs is complicated by pelvic tilt and the two-dimensional nature of plain films. We performed a study to validate the diagnostic accuracy of the crossover sign (COS) and the posterior wall sign (PWS) in identifying acetabular retroversion.

Method

COS and PWS were evaluated from radiographs and computed tomography (CT) scans as the standard of reference in 50 hips of subjects with symptoms of FAI. A CT-based method using 3-D models was developed to measure the COS, PWS, true acetabular version and pelvic tilt relative to the anterior pelvic plane. The new CT-based method aimed to eliminate errors resulting from variations in the position and orientation of the pelvis during imaging.