Surgical Repair of Chronic Tears of the Hip Abductor Mechanism

Abstract

Lateral sided hip pain frequently presents to the orthopaedic clinic. The most common cause of this pain is trochanteric bursitis. This usually improves with conservative treatment. In a few cases it doesn't settle and warrants further investigation and treatment. We present a series of 28 patients who underwent MRI scanning for such pain, 16 were found to have a tear of their abductors. All 16 underwent surgical repair using multiple soft tissue anchors inserted into the greater trochanter of the hip to reattach the abductors. There were 15 females and 1 male. All patients completed a self-administered questionnaire pre-operatively and 1 year post-operatively. Data collected included: A visual analogue score for hip pain, Charnley modification of the Merle D'Aubigne and Postel hip score, Oxford hip score, Kuhfuss score of Trendelenburg and SF36 scores.Of the 16 patients who underwent surgery 5 had a failure of surgical treatment. There were 4 re ruptures, 3 of which were revised and 1 deep infection which required debridement. In the remaining 11 patients there were statistically significant improvements in hip symptoms. The mean change in visual analogue score was 5 out of 10 (p=0.0024) The mean change of Oxford hip score was 20.5 (p=0.00085). The mean improvement in SF-36 PCS was 8.5 (P=0.0020) and MCS 13.7 (P=0.134). 6 patients who had a Trendelenburg gait pre-surgery had normal gait 1 year following surgery.We conclude that hip abductor mechanism tear is a frequent cause of recalcitrant trochanteric pain that should be further investigated with MRI scanning. Surgical repair is a successful operation for reduction of pain and improvement of function. However there is a relatively high failure rate.

Surgical Technique: Gluteus Maximus and Tensor Fascia Lata Transfer for Primary Deficiency of the Abductors of the Hip

“…It can cause gait dysfunction and pain. The described treatments for this condition are inconsistently successful [4,5,9,11,14,16]. The current study demonstrated, in both the laboratory and clinical setting, the TFL and anterior portion of the gluteus maximus were conveniently positioned for transfer to the greater trochanter to substitute for deficient gluteus medius and minimus muscles.…”

“…Spontaneous complete avulsion of the abductor muscles of the hip or avulsion as a complication of chronic trochanteric bursitis may cause severe limp and often is accompanied by pain [3,5]. Simple repair of the abductor tendons and muscle often is successful [4,9,14], but the failure rate is high [5,11,16], leaving deficiencies in the muscle and tendon that cannot be repaired with direct suturing.…”

“…Simple repair of the abductor tendons and muscle often is successful [4,9,14], but the failure rate is high [5,11,16], leaving deficiencies in the muscle and tendon that cannot be repaired with direct suturing. Augmented repair using Achilles tendon allograft has been used with some success in a small series of patients [6].…”

Hip Abductor Tendinopathy: Work-Up and Open Versus Arthroscopic Repair of Hip Abductor

“…Historically, the open technique has championed a high level of patient satisfaction with objective merits such as quantifiable improvements in abductor tendon strength and gait [12,[29][30][31]. In 2009, Voos et al [4,32] [1].…”

Endoscopic Repair of Full-Thickness Gluteus Medius Tears

“…Open repair techniques have included repairs using both transosseous sutures 6 and suture anchors. 8 Few reports have been published on the outcomes of open repairs. The collective series of studies suggests that most patients respond favorably.…”