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Osteotomy of the greater trochanter: effect on gluteus medius function

Beck, Martin ; Krüger, A. ; Katthagen, C. ; Kohl, S.

In: Surgical and Radiologic Anatomy, 2015, vol. 37, no. 6, p. 599-607

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    Titre
    • Osteotomy of the greater trochanter: effect on gluteus medius function
    Auteur
    • Beck, Martin. Clinic for Orthopedic and Trauma Surgery, Luzerner Kantonsspital, 6004, Lucerne, Switzerland
    • Krüger, A.. Department of Orthopedic Surgery, University of Bern, Inselspital, 3010, Bern, Switzerland
    • Katthagen, C.. Department of Trauma and Reconstructive Surgery, Diakoniekrankenhaus Friederikenstift GmbH, 30169, Hannover, Germany
    • Kohl, S.. Department of Orthopedic Surgery, University of Bern, Inselspital, 3010, Bern, Switzerland
    Type de document
    • Postprint
    Langue
    • Inglese
    Publié dans
    • Surgical and Radiologic Anatomy, 2015, vol. 37, no. 6, p. 599-607. Springer Paris
    Autre version électronique
    Identifiant OAI-PMH
    • oai:doc.rero.ch:332420
    Summary
    Purpose: Advancement of the greater trochanter alters the function of the gluteus medius muscle. However, with the exception of clinical studies and biomechanical lever arm studies, no publications that analyze the consequences of advancement of the greater trochanter on the muscle function exist. The aim of the study was to analyze the mechanical changes of gluteus medius after osteotomy of the greater trochanter in a lab setting. Methods: An anatomical study of origin and insertion of the gluteus medius was carried out on four hips. Based on the dissections, a string model was developed dividing the muscle into five sectors. Changes in muscle fiber length were measured for every 10° of flexion, internal and external rotation and abduction with the trochanter in anatomic, proximalized and distalized positions. Results: Distalization of the trochanter leads to an imbalance of muscle action, moving the isometric sector of the muscle anteriorly with more muscle sectors being active during flexion and less during extension. Stretching of the muscle increases passive forces but decreases the force generation capacity of the muscle and at the same time increased muscle fiber excursion may require more energy consumption, which may explain earlier fatigue of the abductor musculature after distalization of the trochanter. For abduction, distalization of the muscle attachment leads to a change in contraction pattern from isometric to isotonic. Optimal balancing and excursion of the muscle is when the tip of the greater trochanter is at level with the hip rotation center. Conclusions: In hips with high riding trochanter, the optimal position is at the level of the center of hip rotation. Excessive distalization should be avoided. As the conclusions and considerations are based on a lab setting, transfer to clinical practice may not necessarily apply.