Gluteus maximus tendon transfer as a salvage option for painful chronic hip abductor insufficiency: clinical and MRI results with a minimum follow-up of 24 months

Abstract

Introduction: Chronic hip abductor insufficiency is a rare debilitating condition. In cases refractory to conservative treatment and not amenable to direct repair an augmentation becomes necessary. The preferred salvage method at our institution is augmentation with the anterior third of the gluteus maximus tendon. The aim of this study is to describe the results of 8 patients, treated for painful chronic hip abductor insufficiency with gluteus maximus muscle transfer, after a minimal follow-up of 24 months including a full clinical and MRI evaluation of the hip abductors pre- and postoperatively. Methods: We retrospectively reviewed a consecutive series of 8 patients who were surgically managed for painful chronic hip abductor insufficiency. All patients had a Trendelenburg sign, impaired muscle strength (M ⩽ 3) as well as a complete avulsion of the hip abductors with marked fatty degeneration (⩾3). Pain levels, muscle strength, functional scores as well as a postoperative MRI was obtained after a minimal follow-up of 24 months. Results: The mean age of the patients was 69 years, mean follow-up was 35 (26–54) months. Pain was significantly reduced postoperatively to VAS 2.5 from VAS 5 ( p  = 0.046). Trendelenburg sign remained positive in all patients and hip abductor strength did not improve significantly from 2.4 to 3.1 ( p  = 0.19). Complete healing of the transferred tendon was confirmed by MRI in all patients at last follow-up. Conclusions: In the setting of painful chronic hip abductor insufficiency refractory to conservative treatment with advanced muscle degeneration without the possibility of a direct reconstruction the gluteus maximus tendon transfer significantly decreased pain. The effect on hip abductor strength and patient-reported functional outcome scores is limited. Despite the modest results it remains our preferred salvage treatment option for lack of better alternatives. Larger studies are necessary to confirm these findings.