Repair of Symptomatic Partial Gluteus Medius Tear During Total Hip Arthroplasty Through the Direct Anterior Approach

Maldonado, David R.; Diulus, Samantha C.; Meghpara, Mitchell B.; Glein, Rachel M.; Ankem, Hari K.; Lall, Ajay C.; Domb, Benjamin G.

doi:10.1016/j.eats.2020.10.043

Cited by 3 publications

(2 citation statements)

References 29 publications

(34 reference statements)

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“…An open repair technique by Maldonado et al. 16 discussed simultaneous gluteus medius repair during total hip arthroplasty using the direct anterior approach. An endoscopic technique discussed by Merrill et al.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Repair of Partial Gluteus Medius Tear: Staple Configuration With Suture Anchors

Park,

Surucu,

Mahatme

et al. 2024

Arthroscopy Techniques

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Section: Discussionmentioning

confidence: 99%

Endoscopic Repair of Partial Gluteus Medius Tear: Staple Configuration With Suture Anchors

Park,

Surucu,

Mahatme

et al. 2024

Arthroscopy Techniques

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“…However, using the same interval is more difficult due to the difficulty with greater trochanter visualization. As Maldanado et al recommend in their technique, the leg needs to be brought into internal rotation and abduction to visualize the appropriate footprint 11 . Even with this amount of leg manipulation, the trochanter is difficult to visualize, and proper direction of the anchors can be difficult.…”

Section: Discussionmentioning

confidence: 99%

Anterior Total Hip Arthroplasty With Gluteus Medius Repair: A Novel Technique

Schwarzman

Vesperman

Matthew

2023

Techniques in Orthopaedics

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Introduction: Proper function of the gluteus medius muscle is crucial to performance and outcomes following total hip arthroplasty. Gluteus medius tears are reported in up to 20% of patients undergoing hip replacements. The combination of increasing notoriety for the direct anterior approach and the potential for improved patient outcomes necessitates a technique to address gluteus medius tears in conjunction with total hip arthroplasty. Therefore, we present the following novel technique for transtendinous gluteus medius repair in conjunction with a direct anterior approach for total hip arthroplasty. Technique: The patient is placed supine with the operative leg in slight external rotation. An incision is made to the fascia overlying the tensor fascia latae. Blunt dissection is performed to the tensor fascia latae-sartorius interval. The deep rectus fascia is split, identifying the anterior capsule. Arthroplasty is then performed in the usual manner. Once the arthroplasty is completed, the hip capsule is closed, and the gluteus medius is exposed through an anterolateral approach. Once found, the tear is classified. A split in line with the tendon fibers is made in the mid aspect of the tear. Once visualized, the greater trochanter is decorticated, and suture anchors are placed. Sutures are passed and tied sequentially from distal to proximal. Expected Outcomes: Gluteus medius repair patients experience excellent outcomes, with multiple studies showing decreased pain and restoration in the strength of the abductor complex. In the setting of total hip arthroplasty, most patients display adequate abductor strength and no Trendelenburg gait at 5 years postoperative.

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Outcomes Following Primary Total Hip Arthroplasty With Concomitant Gluteus Medius Repair Using the Direct Anterior Approach

Maldonado¹,

Glein²,

Annin³

et al. 2023

Orthopedics

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Outcomes following total hip arthroplasty (THA) with concomitant gluteus medius (GM) repair using the direct anterior approach (DAA) are scarce. The primary purpose of this study was to report patient-reported outcome measures (PROMs) with 2-year follow-up of patients with osteoarthritis and GM tear who underwent primary THA and GM repair through the DAA. The secondary purpose was to compare these outcomes with a benchmark propensity-matched control group who underwent a DAA THA without GM tear. Patients were eligible if they received a primary THA and GM repair via the DAA between January 2015 and October 2018 and had baseline PROMs with 2-year follow-up. Patients were excluded if they had workers' compensation or were unwilling to participate. PROM subanalysis was performed between patients and a propensity-matched control group with DAA THA without GM tear. Fourteen patients were included in the study, all of whom were female. Significant improvement for all PROMs and high rate of achieving the minimal clinically important difference (MCID) at 2-year follow-up were reported. All patients were propensity-matched to 28 patients for sex, age, and body mass index. Preoperative PROMs between groups were similar, and both groups reported comparable improvement, satisfaction, and MCID achievement at 2-year follow-up. Primary THA with concomitant GM repair using the DAA yielded good functional outcomes and a high rate of MCID achievement at 2-year follow-up. Based on these results, the DAA can be used safely to address symptomatic GM tears during THA. Furthermore, these outcomes were comparable to a propensity-matched control group without GM tear. [ Orthopedics . 2023;46(1):39–46.]

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Repair of Symptomatic Partial Gluteus Medius Tear During Total Hip Arthroplasty Through the Direct Anterior Approach

Cited by 3 publications

References 29 publications

Endoscopic Repair of Partial Gluteus Medius Tear: Staple Configuration With Suture Anchors

Endoscopic Repair of Partial Gluteus Medius Tear: Staple Configuration With Suture Anchors

Anterior Total Hip Arthroplasty With Gluteus Medius Repair: A Novel Technique

Outcomes Following Primary Total Hip Arthroplasty With Concomitant Gluteus Medius Repair Using the Direct Anterior Approach

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