Repair of a Deficient Abductor Mechanism with Achilles Tendon Allograft After Total Hip Replacement

Fehm, Michael N.; Huddleston, James I.; Burke, Dennis W.; Geller, Jeffrey A.; Malchau, Henrik
October 2010
Journal of Bone & Joint Surgery, American Volume;10/6/2010, Vol. 92-A Issue 13, p2305
Academic Journal
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.


Related Articles

  • Achilles tendon allograft shows promise for repairing failed hip abductors post-THA. Rapp, Susan M. // Orthopedics Today;Sep2009, Vol. 29 Issue 9, p10 

    The article describes a study which investigated the use of Achilles tendon allograft as a reconstruction method for repairing failed hip abductors following total hip arthroplasty (THA).

  • Allogeneic Cancellous Bone Graft and a Burch-Schneider Ring for Acetabular Reconstruction in Revision Hip Arthroplasty. Winter, E.; Piert, M.; Volkmann, R.; Maurer, F.; Eingartner, C.; Weise, K.; Weller, S. // Journal of Bone & Joint Surgery, American Volume;Jun2001, Vol. 83-A Issue 6, p862 

    Background: There is an ever-increasing number of failed hip arthroplasties associated with massive deficiency of acetabular bone stock consisting of a segmental or cavitary defect. This study was undertaken to evaluate the long-term results after use of morselized cryopreserved allogeneic bone...

  • Part II: The Role of Allografts in Revision Arthroplasty of the Hip. Gross, Allan E.; Blackley, Hugh; Wong, Paul; Saleh, Khaled; Woodgate, Ian // Journal of Bone & Joint Surgery, American Volume;Apr2002, Vol. 84-A Issue 4, p655 

    Analyzes the role of allografts in revision hip arthroplasty. Introduction of proximal femoral allografts for construction of bone stock in revision arthroplasty; Attachment of bone and soft tissue and restoration of the correct anatomy via structural grafts; Application of morselized and...

  • Q&A. Luke, Anthony // ACSM Fit Society Page;Fall2012, p2 

    The article presents questions and answers related to sports medicine which include chronic Achilles tendon pain and hip replacement surgery.

  • HISTOLOGICAL FINDINGS IN A PROXIMAL FEMORAL STRUCTURAL ALLOGRAFT TEN YEARS FOLLOWING REVISION TOTAL HIP ARTHROPLASTY. Hamadouche, Moussa; Kerboull, Luc; Kerboull, Marcel; Blanchat, Cinderella; Meunier, Alain // Journal of Bone & Joint Surgery, American Volume;Feb2002, Vol. 84-A Issue 2, p269 

    Focuses on the histological findings in a proximal femoral structural allograft ten year following total hip arthroplasty revision. Inclusion of anticoagulation therapy , systemic antibiotics and nonstroidal anti-inflammatory drugs in the postoperative treatment; Evaluation of the density of...

  • Structural allograft and cemented long-stem prosthesis for complex revision hip arthroplasty: use of a trochanteric claw plate improves final hip function. Laurent Vastel; Camille Lemoine; Marcel Kerboull; Jean Courpied // International Orthopaedics;Dec2007, Vol. 31 Issue 6, p851 

    Abstract  Extensive bone loss raises formidable challenges in total hip revision. The aim of this study was to evaluate the results of reconstruction using a cemented long-stem and massive structural allograft implanted in a filleted proximal femur, with and without the use of a...

  • Strut allograft invasion by Paget's disease of bone: a case report. Cameron, Hugh U.; Cameron, H U; Fornasier, V L; Van Zyl, D V // Canadian Journal of Surgery;Apr2000, Vol. 43 Issue 2, p140 

    Presents a case on strut allograft invasion by Paget's bone disease. Pathophysiology of Paget's disease; Patient profile and medical history; Provision of temporary strengthening of the femur by strut allografts; Preference for hip replacement with a very long stem in the management of Paget's...

  • Trabecular metal acetabular revision system (cup-cage construct) to address the massive acetabular defects in revision arthroplasty. Malhotra, Rajesh; Kancherla, Ramprasad; Kumar, Vijay; Soral, Aditya // Indian Journal of Orthopaedics;Jul/Aug2012, Vol. 46 Issue 4, p483 

    The increasing number of total hip replacements in the younger clique has added to the demand for revision procedures. Revision situations are often encountered with infection, loss of bone stock and bone defects. There are various methods of reconstruction of acetabular defects. The management...

  • Acetabular revision using a total acetabular allograft. Malhotra, Rajesh; Kumar, Vijay // Indian Journal of Orthopaedics;Apr-Jun2009, Vol. 43 Issue 2, p218 

    The most challenging aspect of an acetabular revision is the management of severe bone loss, which compromises implant fixation and stability. We present a case of failed acetabular revision with extensive bone loss (Paprosky Type 3b) in a 50-year-old woman with rheumatoid arthritis, which was...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics