Gluteus Medius Surgery
Gluteus Medius Repair
If there is significant damage to your gluteus medius tendon which cannot heal with conservative treatment (eg.rehabilitation, physical therapy, NSAIDs, and assisted walking devices), surgical repair may be recommended.
The main goal of surgical repair of the gluteus medius is to reattach the tendon to the greater trochanter. This is accomplished by anchoring down the tendon to the bone using small anchor sutures. Depending on the severity/grade of the gluteus medius tear, different approaches may be used for surgical repair.
Smaller, partial-thickness tears of the gluteus medius are typically repaired through atrans-tendinous endoscopic repair. This surgery can be performed arthroscopically (through smallarthroscopic portals with fiber-optic video camera guidance). In this procedure, the surgeon will perform a trochanteric bursectomy to expose the insertion sites of the gluteus medius muscleon the greater trochanter. The surgeon will then clean up the insertion sites of the gluteusmedius on the greater trochanter (known as creating the “bony bed”) and insert anchors and sutures to which the gluteus medius muscle will attach. If the surgeon determines that you have a massive, full-thickness gluteus medius tendon tear, another arthroscopic procedure, known as a double row repair, may be recommended for your repair.
In extreme cases of massive, fully-retracted tears, an open repair might also be recommended.In such a procedure, a 6 cm incision will be made on the lateral buttocks region to expose the tear. If there is prolonged damage to the gluteus medius tendon leading to calcification, this portion of the tendon will be surgically removed. The tear will then be repaired by anchoring down the muscle to the greater trochanter using anchors and sutures.
In some cases, repair of the gluteus medius tendon is not possible due to prolonged injury tot he gluteus medius tendon leading to muscle retraction and atrophy. In such cases, allografts can be used to augment the repair tissue. Apart from this, a transfer of the anterior portion of the gluteus maximus to the greater trochanter may be preferred as a salvage approach in these cases.
Pre-Operative and Post-Operative Instructions
Before performing the surgical repair of the gluteus medius tendon, Dr. Jorge Chahla’s team will provide pre-operative instructions (eg. medications and dietary restrictions). You will likely need time off from work/physical activity.
After the procedure, you will be expected to wear a hip brace and use crutches for the first 4weeks of healing. Physical therapy and rehabilitation will be required between weeks 4 and 12to gradually regainrange-of-motion and strengthen the hip abductors. Once sufficient progress has been made in restoring strength, the patient will be weaned off physical therapy. A complete recovery and return to full activities may take 3-4 months