Reference suture of gluteus minimus muscle: a modification of the lateral approach in total hip arthroplasty

Abstract

The lateral approach is one of the most frequently used surgical procedures in total hip arthroplasty, being its main disadvantage the postsurgical abductor muscle weakness that many patients present, which may lead to Trendelenburg gait in a high percent of cases. For this reason we propose a surgical variation which consists in using a suture reference for the gluteus minimus just before its tenotomy, that allows a better repair of the abductor musculature during the closure. It also facilities muscles mobilization during the dissection, reducing the risk of neurovascular damage if we place an additional retractor, and also protects the gluteus minimus and gluteus medium during the insertion of the prosthetic components. With these advantages, we aim to reduce the most frequent complication of the lateral approach as it is the abductor muscle weakness. This modification only consists in a new suture, so it does not implies additional complications in contrast with the classical approach. However, in some patients can be difficult to place the suture if they have a tendinous deterioration of the gluteus minimus or a chronic break.