Assessment of hip abductors by MRI after total hip arthroplasty and effect of fatty atrophy on functional outcome

Abstract

ObjectivesThe aim of this study was to evaluate how fatty atrophy (FA) of the hip abductors in operated and non-operated hips affected the functional outcome following arthroplasty.MethodsForty-four hips of 22 patients (8 males and 14 females; mean age: 60 ± 14.4 (range: 24–84)) who matched the inclusion criteria and willing to participate in the study were retrospectively evaluated. The mean follow-up was 13.8 ± 2.3 (range: 10–18) months Magnetic resonance imaging (MRI) and Harris Hip Score (HHS) were used to evaluate muscle degeneration and functional outcome after unilateral THA through a posterolateral approach. The FA grade was evaluated using Goutallier grading system. Non-operated hips of subjects were used as the control. Age, duration after the operation, gluteal muscle FA, and the relationships with HHS were evaluated.ResultsFA was more evident in the operated hip (p < 0.05), and was more in the gluteus minimus than in the gluteus medius in both hips (p < 0.05). Patients' age was not correlated with gluteal muscle FA in the operated hip (p > 0.05), whereas there was a positive correlation with the contra-lateral hip (p < 0.05). Duration after surgery did not affect gluteal muscle FA in the operated hip. Older age and FA of either the operated or healthy hip resulted in poorer HHS (p < 0.05). HHS had the strongest correlations with patient age (p < 0.001) and FA (p = 0.026) of the gluteus minimus of contralateral hip.ConclusionFollowing THA, there was marked FA in the operated hip compared to that in the contralateral hip. In these cases, degree of FA in the replaced hip did not correlate with patients' age. Fatty atrophy of the gluteus minimus precedes that of gluteus medius. FA of the contralateral gluteus minimus and patient age are strongly correlated with lower HHS. Level of evidence: Level IV, diagnostic study.Level of evidenceLevel IV, diagnostic study.

Cell therapy to improve regeneration of skeletal muscle injuries

“…These injuries occur during almost any invasive surgical procedure including aggressive tumour ablations and joint revision arthroplasties. Among orthopaedic procedures, total hip arthroplasty (THA) is known to cause severe muscle damage mainly due to lacerations or crush trauma, procedures that are necessary to gain access to the hip joint . The frequency of joint replacement surgeries has reached many hundreds of thousands per year in accordance with the desire of an ageing population to improve their quality of life .…”

“…An overwhelmingly large proportion of these patients shows signs of impaired muscle functionality, fatty degeneration, and scar tissue formation in their yearly follow‐ups . The gluteus minimus, gluteus medius, the abductor, and adductor muscle groups are affected the most by trauma due to THA . Gradual muscle degeneration after the surgical procedure not only causes pain and irritation but also predisposes the patient to limping, hip dislocation, and re‐injury .…”

“…Among orthopaedic procedures, total hip arthroplasty (THA) is known to cause severe muscle damage mainly due to lacerations or crush trauma, procedures that are necessary to gain access to the hip joint. 51 The frequency of joint replacement surgeries has reached many hundreds of thousands per year in accordance with the desire of an ageing population to improve their quality of life. 52,53 An overwhelmingly large proportion of these patients shows signs of impaired muscle functionality, fatty degeneration, and scar tissue formation in their yearly follow-ups.…”

“…54,55 The gluteus minimus, gluteus medius, the abductor, and adductor muscle groups are affected the most by trauma due to THA. 51,56 Gradual muscle degeneration after the surgical procedure not only causes pain and irritation but also predisposes the patient to limping, hip dislocation, and re-injury. 57 It is pertinent to note that these iatrogenic injuries and consequential pathologies even occur after what is commonly considered as a successful primary or revision THA procedure.…”

Association of Preoperative Gluteal Muscle Fatty Infiltration With Patient Outcomes in Women After Hip Abductor Tendon Repair Augmented With LARS

“…While magnetic resonance imaging (MRI) has demonstrated reliability in clinically evaluating the presence and severity of hip abductor tendon tears, 8,27,42 it has also been employed to evaluate gluteal muscle atrophy and/or FI. 15,28,30,42 Muscle atrophy is associated with hip abductor tendon tears, particularly larger tears, 8 and it has been reported that the presence of atrophy in the gluteus medius and/or minimus on imaging should direct the attention of the radiologist toward the distal tendons for signs of a tear. 8 Much like the shoulder, various systems for grading the severity of fatty atrophy in the gluteal muscles have been reported, 15 generally with good intrarater repeatability and interobserver agreement.…”