Gluteus maximus tendon transfer for chronic abductor insufficiency: the Geneva technique

Abstract

Introduction: The treatment options of chronic abductor insufficiency in the setting of muscle degeneration, are limited and technically demanding. We present the outcomes of a salvage technique for unreconstructable, chronic abductor tears performed by a single surgeon. Methods: We retrospectively evaluated 38 patients who were surgically managed for chronic abductor insufficiency. Patients without hip implants and patients following primary or revision total hip arthroplasty (THA) were involved. All patients had a Trendelenburg gait, impaired muscle strength of abduction (⩽M4) and fatty degeneration of muscles (Goutallier ⩾3). They underwent transfer of a flap of the anterior third of gluteus maximus to the greater trochanter that was sutured under the slightly mobilised vastus lateralis. The level of pain, functional scores, muscle strength and Trendelenburg gait were re-evaluated at 12 postoperative months. Results: The mean age of patients was 70.2 years. 10 patients received the tendon transfer on a native hip, 6 following primary THA and 22 after revision THA. The mean pain level (3.2 vs. 7, p < 0.001) and Harris Hip Score (80.2 vs. 41.6, p < 0.001) and the median abductor strength (4 vs. 3, p < 0.001) was significantly improved compared to the preoperative scores. 26 patients demonstrated negative and 12 positive Trendelenburg sign at 12 postoperative months. No serious complications were reported. Conclusions: This salvage technique improved the strength of abduction and functional results and reduced the level of pain in 80% of patients with chronic abductor tears. The short-term outcomes of the procedure were favourable; however, further evaluation is needed.

Constrained liners revisited: favourable mid-term results in patients with high-risk of dislocation: technical considerations for the optimal outcome

“…The augmentation of hip abductors with the transfer of a part of gluteus maximus to the major trochanter was also performed. 18 There were no further revisions or dislocations in this case-series. No loosened cup was found in any of the patients at the last follow-up.…”

Short-term outcomes following mini-open repair of chronic gluteus medius tendon tears using a double-row technique

“…Gluteal tendon tears represent a common but underreported cause of hip pain and dysfunction [ 25 ]. While such lesions have been reported following total hip arthroplasty [ 8 , 26–28 ] or traumatic events [ 5 , 29 , 30 ], the prevalence of chronic tears in patients suffering from GTPS is high and should not be ignored. To date, these degenerative and inflammatory lesions become a matter of particular interest [ 31–36 ], notably, because of the global population ageing related to advances in medical technologies.…”

“…gluteus medius (GM) and gluteus minimus] constitute a common but underreported source of peritrochanteric pain, irritation, muscle weakness and gait dysfunction [ 4–7 ]. They occur in a considerable proportion of the middle-aged population, notably in women for whom the incidence reaches 25%, compared to only 10% in men [ 8 , 9 ]. A recent literature review furthermore underlined that abductor tendinopathy increases with age, with a prevalence exceeding 80% in elderly patients (≥70 years) without hip-related problems [ 10 ], thus emphasizing the importance of systematic and thorough patient examination for avoiding misdiagnosis [ 11 ].…”

Gluteus Maximus Transfer following Total Hip Arthroplasty Does Not Improve Abductor Moment: A Case-Control Gait Analysis Study of 15 Patients with Gluteus Medius Disruption

“…Better clinical results after gluteus maximus transfer for the treatment of abductor insufficiency were reported by Christofipoulos et al [ 31 ]. This study included 38 patients with variable hip history (native hips, after primary and secondary hip replacements) and demonstrated improvements in pain, the Harris Hip Score and abductor strength.…”