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. 2025 Oct 10:36:101861.
doi: 10.1016/j.artd.2025.101861. eCollection 2025 Dec.

Global Hip Offset is an Important Factor in the Success of Abductor Mechanism Insufficiency Repair After Total Hip Arthroplasty: A Case Series

Samo Roškar  1   2 , Neža Trebše  2 , René Mihalič  1   2 , Nejc Kurinčič  1 , Mateja Blas  3 , Rihard Trebše  1   2
Affiliations

Global Hip Offset is an Important Factor in the Success of Abductor Mechanism Insufficiency Repair After Total Hip Arthroplasty: A Case Series

Samo Roškar et al. Arthroplast Today. .

Abstract

Background: Hip abductor mechanism deficiency due to abductor tendon degeneration, tear, or intraoperative damage during total hip arthroplasty (THA) may cause severe walking disability. For severe abductor weakness in native hip joints, Whiteside muscle transfer is a good solution. However, the literature on the results of abductor mechanism reconstruction (AMR) after THA remains limited. Our study aimed to assess the outcome of AMR in patients with THA suffering from Milwaukee III and IV hip abductor deficiency.

Methods: We conducted a single-center retrospective cohort study of THA with hip abductor mechanism deficiency treated surgically with AMR. Data were collected between January 2011 and December 2019 and included the following parameters: patient's data, subjective level of pain, Harris Hip Score (HHS), gait pattern, extent of hip abductor tear, and offset measurements.

Results: The cohort included 16 THAs with AMR in 16 patients. The whole group median HHS improved from 37.1 interquartile range (IQR) (31.0-38.7) to 73.9 IQR (63.5-83.7) (P < .001). In a subgroup of 9 hips, the global offset was preserved after THA while it was reduced in remaining 7 hips. All patients with preserved global offset had significantly better clinical outcome compared to the group with reduced global offset (median HHS improvement was 48 IQR [46-53] compared to 22 IQR [18-25], P = .001).

Conclusions: Our study showed favorable outcome of the AMR for chronic, Milwaukee III and IV hip abductor deficiency after THA. It is the first study to show that restoration of global offset after THA is of utmost importance to avoid chronic abductor mechanism deficiency.

Keywords: Abductor reconstruction; Abductor repair; Gluteus transfer; Offset; Whiteside procedure.

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Figures

Figure 1
Figure 1
Offset measurement as described by Bjarnason and Reikeras.
Figure 2
Figure 2
Change in Harris Hip Score (HHS) (a) and pain on visual analog scale (VAS) (b) for the whole cohort before and after Whiteside procedure.
Figure 3
Figure 3
The change in Harris Hip Score (HHS) related to the offset of the hip joint.
Figure 4
Figure 4
Decreased global offset situation after total hip arthroplasty on the right side.
Figure S1
Figure S1
Patient positioning in the operating theater.
Figure S2
Figure S2
Preparation of the gluteus maximus muscle flap.
Figure S3
Figure S3
Decortication of insertion site on the greater trochanter.
Figure S4
Figure S4
Drilling the holes to decorticated grater trochanter (a) Nonabsorbable sutures passed through predrilled holes for flap attachment (b).
Figure S5
Figure S5
The site of the muscle flap transfer, completely naked greater trochanter.
Figure S6
Figure S6
The final situation with the gluteus maximus fixed on the trochanter in line with vastus lateralis greater trochanter. TFL, tensor fascia latae.
See this image and copyright information in PMC

References

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