Abductor Tear in Total Hip Arthroplasty: A Scoping Literature Review

Background: Tear of the abductor mechanism is a well-known problem. Most of the published studies in that regard comes from the sport literature but little have been published about it in the THA settings. Abductor mechanism plays a crucial part in hip stability and limb gait hence an injury to it can lead to pain, weakness, and instability after THA. Objective: To review all studies reporting on abductor tear or insufficiency in Total Hip Arthroplasty and present the current state of literature on that. Methods: The Author completed an electronic database search of PubMed, EMBASE and PubMed Central to identify any studies reporting on Abductor mechanism and Total Hip Arthroplasty from the date of inception of the databases until August 2018. The author followed the PRISMA guidelines. The author extracted and summarized data from the identified studies. Only Studies published in the English literature and reported data on Abductor mechanism tear with THA were included. Results: 566 studies were identified. 32 studies met the inclusion criteria and were included in this review. Tear of hip abductor in THA were reported to be between 11-25%. It was more prevalent in women, older age population with no association to comorbidities. There is no clear evidence that the incidence of abductor weakness is higher in lateral than posterior approaches, contrary to the popular opinion. Surgical reconstruction techniques for chronic abductor insufficiency showed good results in the short-term regarding pain and function. Conclusions: Abductor mechanism tear after THA is a known complication that should be considered in patients with substantial lateral hip pain, limb and weak abduction following THA. Repair of the abductors can improve pain, function, and limb in three fourth of the patients specially if identified and repaired early. Promising results have been published for abductor reconstruction procedures for recurrent or chronic tears in short term follow-ups but still lack the long-term results.