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| Name | Class |
|---|---|
| Göteborg University | OTHER |
| Vastra Gotaland Region | OTHER_GOV |
| The Swedish Society of Medicine | OTHER |
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Residual limping after total hip arthroplasty is a serious complication that lacks effective treatment. The purpose of this study is to evaluate a surgical treatment for residual limping and compare its results with non-surgical treatment. Our hypothesis is that surgical treatment followed by physiotherapy increases hip function and reduces limping compared with non-surgical treatment with physiotherapy alone.
Residual limping due to gluteus medius insufficiency after total hip arthroplasty is a serious complication that lacks effective treatment. The purpose of this study is to evaluate surgical reconstruction of gluteus medius using Achilles tendon allograft and compare its results and adverse events with non-surgical treatment. Our hypothesis is that surgical reconstruction followed by physiotherapy increases hip function and reduces limping compared with non-surgical treatment with physiotherapy alone.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Surgical reconstruction | Experimental | 22 patients undergo surgical reconstruction of gluteus medius with allograft consisting of Achilles tendon with calcaneus block. The calcaneus block is fixed into the greater trochanter and the Achilles tendon i passed through the gluteus medius muscle, tensioned and sutured into the muscle. Postoperatively, partial weight bearing for 2 months followed by physiotherapy for 10 months. |
|
| Physiotherapy | No Intervention | 22 patients receive non-operative treatment for their limp with physiotherapy alone during a 12-month period. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Surgical reconstruction of gluteus medius with Achilles tendon allograft | Procedure | Achilles tendon allograft i fixed between the gluteus medius muscle and the greater trochanter |
| Measure | Description | Time Frame |
|---|---|---|
| Oxford Hip Score (OHS) | Patient-reported hip function measured in a scale 0-48 | 12 months |
| Measure | Description | Time Frame |
|---|---|---|
| Trendelenburg's sign | Presence or abscence of Trendelenburg's sign as binary outcome (yes/no) | 12 months |
| Hip abduction torque | Abduction torque in the frontal plane measured in Nm/Kg with gait analysis |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Georgios Tsikandylakis, MD, PhD | Sahlgrenska University Hospital | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Sahlgrenska University Hospital | Recruiting | Mölndal | 431 80 | Sweden |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 31146555 | Background | Whiteside LA, Roy ME. Incidence and treatment of abductor deficiency during total hip arthroplasty using the posterior approach: repair with direct suture technique and gluteus maximus flap transfer. Bone Joint J. 2019 Jun;101-B(6_Supple_B):116-122. doi: 10.1302/0301-620X.101B6.BJJ-2018-1511.R1. | |
| 22410129 | Background |
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| ID | Term |
|---|---|
| D018908 | Muscle Weakness |
| D009133 | Muscular Atrophy |
| D007383 | Intermittent Claudication |
| ID | Term |
|---|---|
| D009135 | Muscular Diseases |
| D009140 | Musculoskeletal Diseases |
| D020879 | Neuromuscular Manifestations |
| D009461 | Neurologic Manifestations |
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Randomized controlled trial with the option of crossover in the control group after a certain period of time.
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|
| 12 months |
| University of California Level of Activity (UCLA) | Patient-reported activity level measured with in a rank scale 0-10 | 12 months |
| Euroqol 5 dimension 5 level index (EQ5D-5L) | Patient-reported health-related quality of life measured with swedish version of the euroqol 5 dimension 5 level index in a scale 0-1 | 12 months |
| Euroqol visual analog scale (EQVAS) | Patient-reported health-related quality of life measured with the euroqol visual analog scale 0-100 | 12 months |
| Adverse events | All complications resulting in contact with health care provider within one year. | 12 months |
| Ewen AM, Stewart S, St Clair Gibson A, Kashyap SN, Caplan N. Post-operative gait analysis in total hip replacement patients-a review of current literature and meta-analysis. Gait Posture. 2012 May;36(1):1-6. doi: 10.1016/j.gaitpost.2011.12.024. Epub 2012 Mar 10. |
| 21796476 | Background | Whiteside LA. Surgical technique: Transfer of the anterior portion of the gluteus maximus muscle for abductor deficiency of the hip. Clin Orthop Relat Res. 2012 Feb;470(2):503-10. doi: 10.1007/s11999-011-1975-y. |
| 20926725 | Background | Fehm MN, Huddleston JI, Burke DW, Geller JA, Malchau H. Repair of a deficient abductor mechanism with Achilles tendon allograft after total hip replacement. J Bone Joint Surg Am. 2010 Oct 6;92(13):2305-11. doi: 10.2106/JBJS.I.01011. |
| 25441700 | Background | Beard DJ, Harris K, Dawson J, Doll H, Murray DW, Carr AJ, Price AJ. Meaningful changes for the Oxford hip and knee scores after joint replacement surgery. J Clin Epidemiol. 2015 Jan;68(1):73-9. doi: 10.1016/j.jclinepi.2014.08.009. Epub 2014 Oct 31. |
| D009422 | Nervous System Diseases |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D012816 | Signs and Symptoms |
| D001284 | Atrophy |
| D020763 | Pathological Conditions, Anatomical |
| D058729 | Peripheral Arterial Disease |
| D016491 | Peripheral Vascular Diseases |
| D014652 | Vascular Diseases |
| D002318 | Cardiovascular Diseases |