Repair of a Deficient Abductor Mechanism with Achilles Tendon Allograft After

Total Hip Replacement

ABSTRACT
Abductor mechanism insufficiency after total hip arthroplasty is a rare
complication, often presenting with severe dysfunction among patients. Dysfunction
include severe pain, limp and general sense of dysfunction. Among the difficulties
presented by the complication is the diagnosis of the disease and treatment options to
successfully correct or improve the functionality of the patient. The purpose of this
study is to examine the response of patients to a treatment modality involving freshfrozen Achilles tendon allograft with an attached calcaneal bone graft. The study is a
retrospective study from 2003 to 2006, wherein seven patients, with abductor
insufficiency secondary to total hip athroplasty with a mean of twenty-nine months after
surgery, were assessed for lateral hip pain and abductor muscle weakness. Harris hip
score and average pain scores where used along with Trendelenburg test to assess the
severity of dysfunction. Using arthrogram, abductor tendon rupture was diagnosed and
confirmed during surgery. After total hip replacement, the average Harris hip score was
34.8 points and the average pain score was 11.4. Post abductor insufficiency repair and
a minimum follow up of twenty four months, the average Harris hip score improved to
85.9 points and the average pain score to 38.9 points. In conclusion, the repair of
abductor insufficiency using Achilles tendon Allograft with calcaneal bone attached to
the greater trochanter can significantly improve pain relief, abductor muscle strength,
decrease limp and improve Trendelenburg sign during the early follow up patients.