SpringerLink
Log in

Could the tendon degeneration and the fatty infiltration of the gluteus medius affect clinical outcome in total hip arthroplasty?

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Purpose

The aim of this prospective study was to perform a clinical and radiologic evaluation of patients undergoing total hip arthroplasty (THA). The hypothesis is that there is a correlation between the pre-operative degeneration state of the gluteal muscle-tendinous unit and the clinical outcome in terms of functional recovery.

Methods

Fifty-five patients have met inclusion criteria. All patients included in the sample were subjected to clinical evaluation. The ultrasound examination of the patients of the study was conducted and the following parameters were assessed: Thickness in mm of the gluteus medius tendon; Quality of the gluteus medius tendon; and Trophy and muscular composition.

Results

The degree of degeneration of the pre-operative tendon shows a negative statistical correlation with all the pre- and post-operative clinical scales, but presents statistical significance (p < 0.05) only with the post-operative Harris, the post-operative Oxford, the Harris and HOOS-modified post-operative, lameness, and Trendelenburg; it correlates positively with the quality of the macroscopic tendon detected intra-operatively, the degree of the pre-operative contralateral tendon, and the operated and contralateral pre-operative muscle (p < 0.05). The degree of fatty degeneration of the pre-operatively operated muscle correlates negatively (p < 0.05) with all pre- and post-operative clinical scales except for the pre-operative WOMAC and HOOS modified, with the lameness and the Trendelenburg sign; it correlates positively (p < 0.05) with age, the quality of the macroscopic tendon detected intra-operatively, degree of tendon degeneration, fatty infiltration of the contralateral pre- and post-operative muscle and of the post-operative operated muscle.

Conclusion

Tendon degeneration and fatty infiltration of the gluteus medius muscle appeared to be determinants of the post-operative persistence of lameness and Trendelenburg sign positivity in patients undergoing hip arthroplasty.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price includes VAT (Canada)

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Graph 1

Similar content being viewed by others

References

  1. Arden NK, Kiran A, Judge A et al (2011) What is a good patient reported outcome after total hip replacement? Osteoarthr Cartil 19(2):155–162

    Article  CAS  Google Scholar 

  2. Gandhi R, Davey JR, Mahomed NN (2008) Predicting patient dissatisfaction following joint replacement surgery. J Rheumatol 35:2415–2418

    Article  Google Scholar 

  3. Espehaug B, Havelin LI, Engesaeter LB, Langeland N, Vollset SE (1998) Patient satisfaction and function after primary and revision total hip replacement. Clin Orthop Relat Res 351:135–148

    Article  Google Scholar 

  4. Brown TE, Larson B, Shen F, Moskal JT (2002) Thigh pain after cementless total hip arthroplasty: evaluation and management. J Am Acad Orthop Surg 10:385–392

    Article  Google Scholar 

  5. Bozic KJ, Rubash HE (2004) The painful total hip replacement. Clin Orthop Relat Res.: 18–25

    Article  Google Scholar 

  6. De Maeseneer M, Gosselin R, De Ridder F, Shahabpour M, Vanderdood K (2009) MR imaging changes in the trochanteric area of asymptomatic individuals: a potential for misdiagnosis of pain in the trochanteric region. Eur J Radiol 72:480–482

    Article  Google Scholar 

  7. Garellick G, Kärrholm J, Rogmarket C, et al. (2009) Swedish Hip Arthroplasty Register. Annual Report 2008. Department of Ortopaedics, Sahlgrenska University Hospital. October

  8. Nikolajsen L, Brandsborg B, Lucht U et al (2006) Chronic pain following total hip arthroplasty: a nationwide questionnaire study. Acta Anaesthesiol Scand 50:495–500

    Article  CAS  Google Scholar 

  9. Bozic KJ, Rubash HE (2004) The painful total hip replacement. Clin Orthop 420:18–25

    Article  Google Scholar 

  10. Fehm MN, Huddleston JI, Burke DW et al (2010) Repair of a deficient abductor mechanism with Achilles tendon allograft after total hip replacement. J Bone Joint Surg Am 92:2305–2311

    Article  Google Scholar 

  11. Grimaldi A, Richardson C, Durbridge G, Donnelly W, Darnell R (2009) Hides J. The association between degenerative hip joint pathology and size of the gluteus maximus and tensor fascia lata muscles. Man Ther. 14: 611–617

    Article  Google Scholar 

  12. Grimaldi A, Richardson C, Stanton W, Durbridge G, Donnelly W, Hides J (2009) The association between degenerative hip joint pathology and size of the gluteus medius, gluteus minimus and piriformis muscles. Man Ther 14:605–610

    Article  Google Scholar 

  13. Pfirrmann CW, Notzli HP, Dora C, Hodler J, Zanetti M (2005) Abductor tendons and muscles assessed at MR imaging after total hip arthroplasty in asymptomatic and symptomatic patients. Radiology 235:969–976

    Article  Google Scholar 

  14. Rasch A, Byström AH, Dalén N, Martinez-Carranza N, Berg HE (2009) Persisting muscle atrophy two years after replacement of the hip. J Bone Joint Surg (Br) 91-B:583–588

    Article  Google Scholar 

  15. Gladstone JN, Bishop JY, Lo IK, Flatow EL (2007) Fatty infiltration and atrophy of the rotator cuff do not improve after rotator cuff repair and correlate with poor functional outcome. Am J Sports Med 35:719–728

    Article  Google Scholar 

  16. Goutallier D, Postel JM, Gleyze P et al (2003) Influence of cuff muscle fatty degeneration on anatomic and functional outcomes after simple suture of full-thickness tears. J Shoulder Elb Surg 12(6):550

    Article  Google Scholar 

  17. Goutallier D, Postel JM, Lavau L, Bernageau J (1999) Impact of fatty degeneration of the supraspinatus and infraspinatus muscles on the prognosis of surgical repair of the rotator cuff [in French]. Rev Chir Orthop Reparatrice Appar Mot 85:668–676

    CAS  PubMed  Google Scholar 

  18. Thomazeau H, Boukobza E, Morcet N, Chaperon J, Langlais. (1997) Prediction of rotator cuff repair results by magnetic resonance imaging. Clin Orthop Relat Res. Nov; (344): 275–83

    Article  Google Scholar 

  19. Müller M, Schwachmeyer V, Tohtz S et al (2012) The direct lateral approach: impact on gait patterns, foot progression angle and pain in comparison with a minimally invasive anterolateral approach. Arch Orthop Trauma Surg 132:725–731

    Article  Google Scholar 

  20. Klässbo M, Larsson E, Mannevik E. Hip disability and osteoarthritis outcome score. An extension of the Western Ontario and McMaster Universities Osteoarthritis Index. Scand J Rheumatol. 2003;32:46–51.

    Article  Google Scholar 

  21. Klassbo M, Larsson E, Mannevik E. Hip disability and osteoarthritis outcome score. An extension of the Western Ontario and McMaster Universities Osteoarthritis Index. Scand J Rheumatol. 2003;32(1):46-51

    Article  Google Scholar 

  22. Dawson J Fitzpatrick R Carr A Murray D Questionnaire on the perceptions of patients about total hip replacement. J Bone Joint Surg Br 1996;78(2):185–190

    Article  Google Scholar 

  23. Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW (1988) Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol 15:1833–1840

    CAS  PubMed  Google Scholar 

  24. Goutallier D, Postel JM, Bernageau J, Lavau L, Voisin MC (1994) Fatty muscle degeneration in cuff ruptures: pre- and postoperative evaluation by CT scan. Clin Orthop Relat Res 304:78–83

    Google Scholar 

  25. Wang T, Shao L, Xu W, Chen H, Huang W (2019) Comparison of morphological changes of gluteus medius and abductor strength for total hip arthroplasty via posterior and modified direct lateral approaches. Int Orthop 2019 3

  26. Khoury V, Cardinal E, Brassard P (2008) Atrophy and fatty infiltration of the supraspinatus muscle: sonography versus MRI. AJR Am J Roentgenol Apr 190(4):1105–1111

    Article  Google Scholar 

  27. Thomazeau H, Rolland Y, Lucas C, Duval JM, Langlais F (1996) Atrophy of the supraspinatus belly: assessment by MRI in 55 patients with rotator cuff pathology. Acta Orthop Scand 67:264–268

    Article  CAS  Google Scholar 

  28. Elia F, Azoulay V, Lebon J, Faraud A, Bonnevialle N, Mansat P (2017) Clinical and anatomic results of surgical repair of chronic rotator cuff tears at ten-year minimum follow-up. Int Orthop 41(6):1219–1226

    Article  Google Scholar 

  29. Muller M, Tohtz S, Winkler T, Dewey M, Springer I, Perka C (2010) MRI findings of gluteus minimus muscle damage in primary total hip arthroplasty and the influence on clinical outcome. Arch Orthop Trauma Surg 130:927–935

    Article  Google Scholar 

  30. Fabbri M, De Carli A, Ciompi A, Lanzetti RM, Vadalà A, Lupariello D, Iorio C, Serlorenzi P, Argento G, Ferretti A. (2016) Muscle atrophy and fatty infiltration in rotator cuff tears: can surgery stop muscular degenerative changes? Journal of Orthopaedic Science.; Volume 21 No.5 (article in press)

  31. Einar A, Leif IH, Ove F, Valborg B, Lars N, Oystein H, Sigbjorn D (2014) Worse patient-reported outcome after lateral approach than after anterior and posterolateral approach in primary hip arthroplasty. Acta Orthop 85(5):463–469

    Article  Google Scholar 

  32. Bremer AK, Kalberer F, Pfirrmann CW et al (2011) Soft-tissue changes in hip abductor muscles and tendons after total hip replacement: comparison between the direct anterior and the transgluteal approaches. J Bone Joint Surg (Br) 93:886–889

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Sant’Andrea Hospital, University of Rome “La Sapienza”, Via di Grottarossa, 1035, 00189, Rome, Italy

    Antonio Pasquale Vadalà, Daniele Mazza, Davide Desideri, Raffaele Iorio, Gianluca Fedeli, Marco Scrivano, Pierluigi Serlorenzi & Andrea Ferretti

Authors
  1. Antonio Pasquale Vadalà
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Daniele Mazza
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Davide Desideri
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Raffaele Iorio
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Gianluca Fedeli
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Marco Scrivano
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Pierluigi Serlorenzi
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Andrea Ferretti
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Daniele Mazza.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Vadalà, A.P., Mazza, D., Desideri, D. et al. Could the tendon degeneration and the fatty infiltration of the gluteus medius affect clinical outcome in total hip arthroplasty?. International Orthopaedics (SICOT) 44, 275–282 (2020). https://doi.org/10.1007/s00264-019-04468-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-019-04468-x

Keywords

Search

Navigation