Hip Abductor Augmentation Using Muscle Transfer Technique

 

by Eric Kohn, DPT, OSC, CSCS

Over the past few years, we have seen an increase in failures of total hip surgeries in the media. There are numerous reasons for these failures and one complication is abductor muscle insufficiency. The abductor muscles of the hip stabilize your pelvis when walking. A weakened abductor muscle leads to a gait or walking pattern of limping and lurching to the insufficient side (called Trendelenburg gait) and is very recognizable.

Dr. Nessler—Joint ReplacementThe recalled metal-on-metal replacement hips have 2 main problems. First, the chromium and cobalt used is causing chemical corrosion. Second, there’s micro-motion within the implant itself. These 2 problems can lead to Adverse Local Tissue Reaction (ALTR) and Adverse Reaction to Metal Debris (ARMD). These can cause a breakdown in the abductor muscle of the hip that overlays the implant. The muscle becomes inflamed and begins to die and thus the Tredelenburg gait and failure of the total hip arthroplasty.

Dr. Nessler is one of the few surgeons in the country that performs a highly complex surgery of creating a new abductor muscle from the transfer of the tensor fasciae latae (TFL) and part of the gluteus maximus muscles. Following surgery, the patient follows a conservative rehabilitation that is broken down into four phases. The main outcome goals from the surgery and rehabilitation include decreased pain, improved abductor strength, and decrease Trendelenburg gait.

With increased hip replacement recalls and complications from total hip surgeries, patients now have the opportunity for improvement with the surgery performed by Dr. Nessler and a successful rehabilitation program.

Eric KohnEric Kohn has served at the Orthopedic Sports Center and St. Cloud Orthopedics since 1999. He has a doctorate in physical therapy, specializes in orthopedics and sports medicine, and is the only area physical therapist that is board certified in orthopedics. Dr. Kohn is an adjunct Professor at SJU/CSB, teaching a Sports Medicine/Orthopedics Class. He is also a certified strength and conditioning specialist and the director of the High Energy Advanced Training (HEAT) Program.