Surgical Reconstruction of Irreparable Hip Abductors With the Use of Allograft: A Systematic Review and Meta-analysis of Clinical Outcomes.

Abstract

Chronic hip abductor insufficiency remains a challenging problem to treat and can result in notable disability in some patients. The use of allograft has become an increasingly common option for surgical reconstruction. The purpose of this systematic review was to analyze the clinical outcomes, complications, and revisions rates of patients who underwent allograft reconstruction for irreparable hip abductor tears. PubMed (MEDLINE), Scopus (EMBASE, MEDLINE, COMPENDEX), and Cochrane databases were used to conduct a systematic review. A total of five studies were included, comprising three that used a dermal allograft, one that used an Achilles tendon allograft with a calcaneal bone block, and one that used an extensor mechanism of the knee allograft. Demographics, hip setting (native hip, primary total hip arthroplasty [THA], revision THA), patient-reported outcome measures, presence of Trendelenburg sign, use of walking aids, abduction strength, complication rates, and revision rates were analyzed. A total of 76 patients (76 hips) underwent hip abductor reconstruction with allograft. The mean age was 63.2 years with 84.2% being female. The mean follow-up was 23.6 months. Four studies reported changes in preoperative to postoperative patient-reported outcome measures, all of which demonstrated an improvement in outcomes. The mean preoperative reported abduction strength was 2.7/5, which improved to 3.9/5 postoperatively (P < 0.001). Two studies demonstrated a persistent postoperative Trendeleburg sign in more than one third of patients. The complication and revision rates were 5.3% (4/76) and 1.3% (1/76), respectively. Allograft reconstruction is a salvage procedure for a challenging problem that provides satisfactory clinical outcomes in patients with chronic hip abductor insufficiency not amendable to primary repair. Complication and revision rates were notably low. Future research should compare the clinical outcomes of allograft reconstruction with other muscle transfer techniques to determine the optimal surgical treatment for chronic hip abductor deficiency.