Abductor Deficiency in Total Hip Arthroplasty: Evaluation, Diagnosis, and Treatment Strategies

Abductor deficiency after total hip arthroplasty is a rare and challenging problem facing reconstructive surgeons today. The etiologies are vast. Herein, we review the relevant anatomy of the abductor mechanism, as well as the course and potential sites of injury for the superior gluteal nerve. The diagnosis can be challenging, but a focus on history and physical examination is the most important diagnostic tool. Supplemental modalities include plain radiographs, arthrography, ultrasound, electromyography, and magnetic resonance imaging. A variety of treatments exists for symptomatic abductor deficiency. We review potential modalities ranging from soft tissue transfers, trochanter fixation and osteotomy with a slide, as well as potential revision components.