Area of Focus: Joint Replacement and Hip, Knee & Lower Extremity
Damage to the gluteus medius and minimus muscles is a severe complication of total hip arthroplasty. Such damage is a result of either direct muscular damage or indirect muscular degeneration following injuries to the superior gluteal nerve. The patients quality of life is severely reduced because of gluteal insufficiency with concomitant pelvic instability and Trendelenburg limping. The examiner can easily diagnose such defects by the clinical appearance of positive Trendelenburg sign and the patients inability to stabilize the pelvis during stance on the affected side, which results in a highly deficient gait pattern. An MRI usually reveals fatty degeneration of the gluteus medius and minimus muscles but intact gluteus maximus and tensor fasciae latae (TFL) muscles.
This video demonstrates both the clinical and the radiographic findings in a patient with a severe gluteal deficiency. It explains our proposed concept of utilizing a portion of gluteus maximus and the TFL to replace the abduction force of the deficient gluteal muscles through the creation of crossed flaps mobilized and inserted into the proximal femur.
In consecutive views, the video demonstrates the principal anatomy as well as the preparation of both flaps. After mobilizing the flaps, we demonstrate the way to cross the distal portions of the flaps underneath the vastus lateralis fasciae and fix them to the proximal femur using standard anchors. We also show reconstruction of the abductor cuff. At the end of the video, we present the clinical effects of the proposed technique.
In order to demonstrate both the concept and the surgical technique, we use videos taken during surgery as well as extensive cadaver preparations. We use MRI still and movie sequences to demonstrate the pathology and the muscle quality preoperatively. We have labeled all video sequences in order to demonstrate details and allow for easy orientation and identification of anatomic structures. The video includes full narration.
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