Modified Mostardi approach with ultra-high-molecular-weight polyethylene tape for total hip arthroplasty provides a good rate of union of osteotomized fragments

J Orthop Sci. 2015 Jul;20(4):633-41. doi: 10.1007/s00776-015-0721-9. Epub 2015 Apr 4.

Abstract

Background: A lateral approach is common in total hip arthroplasty because of the good exposure it provides and its low complication rates. However, a drawback of the procedure is that the abductor mechanism is damaged when the tendinous insertion of the abductor muscle is split. Here, we describe a wafer technique using ultra-high-molecular-weight polyethylene tape for promising reattachment of the abductor mechanism.

Methods: We retrospectively evaluated 120 consecutive primary total hip arthroplasties performed using a modified Mostardi approach, which involved reattaching the trochanter using either a braided polyester suture (polyester suture group, n = 60) or ultra-high-molecular-weight polyethylene tape (UHMWPE tape group, n = 60). The osteotomized fragment was reattached by inducing bone-to-bone contact using 3-mm-wide tapes that were precisely tied with a double-loop sliding knot in conjunction with a cable gun tensioner. The abductor strength and radiographic union rate were postoperatively assessed at 4 weeks and 6 months, respectively.

Results: A statistically significant lower incidence of nonunion and cutout was observed in the UHMWPE group (0 and 5.0 %, respectively) compared to the polyester suture group (8.3 and 15 %, respectively). No differences in abductor strength either preoperatively or at 4 weeks postoperatively were observed between the groups. In radiographically healed patients, abductor strength at 4 weeks post-surgery exceeded preoperative strength. The recovery rate of hip abductor strength was 109.9 ± 34.3 % in union patients and 92.9 ± 23.3 % in nonunion patients, which was statistically significant. The mean Japanese Orthopedic Association hip scores improved from 48.6 to 86.8 in union patients and from 50.3 to 85.9 in nonunion patients at 1 year postoperatively; however, this difference was not significant.

Conclusions: The modified Mostardi approach using ultra-high molecular weight polyethylene tape can promote successful union of the osteotomized fragment.

MeSH terms

  • Arthroplasty, Replacement, Hip / instrumentation*
  • Equipment Design
  • Female
  • Femur / surgery*
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Osteoarthritis, Hip / surgery*
  • Polyethylenes*
  • Postoperative Complications / prevention & control
  • Retrospective Studies
  • Surgical Tape*
  • Treatment Outcome

Substances

  • Polyethylenes
  • ultra-high molecular weight polyethylene