Double Row Hip Abductor Reconstruction with Fasciae Latae Transfer for Severe Trendelenburg after Hip Arthroplasty

Abstract

Background/Objectives: Tendinopathy of the gluteus medius and minimus tendons is a primary source of lateral hip pain, ranging from interstitial and partial-thickness tears to complete tears. Treatments include muscle transfers, Achilles tendon allograft procedures, and primary repairs with allografts. This study evaluated the one-year outcomes of gluteus medius and minimus reconstruction using an open double-row technique with a partial tensor fasciae latae transfer for severe Trendelenburg post-total hip arthroplasty. Methods: A prospective study involving eight patients who underwent surgery from April to December 2023 was conducted. The surgery involved an open technique with double-row suture reinforcement and tensor fasciae latae autograft. Outcomes were measured using strength, the Harris Hip Score (HHS), 12-Item Short Form Health Survey (SF-12), Hip Outcome Tool (HOT), International Hip Outcome Tool (iHOT), and Visual Analog Scale (VAS). Follow-ups occurred at 1, 3, 6, 9, and 12 months postoperatively. Results: At an average follow-up of 7.17 months, significant improvements in both hip function and quality of life were observed. The SF-12 quality of life score increased from 27 preoperatively to 34 by month 12. Hip functionality, as measured by the HHS, showed a marked improvement from 48 to 94 points, particularly after six months. The HOT score for hip functionality rose by 23 points by the third month, reaching an average of 86 points. Similarly, the iHOT score increased from 20 to 83 points starting at month 3, reflecting substantial improvements in hip function. Statistically significant improvements were noted at as early as month 3 (p = 0.02), with highly significant gains by month 6 (p < 0.01), which remained stable through month 12 (p < 0.01). Conclusions: Reconstruction of the gluteus medius and minimus tendons using an open double-row technique with a partial tensor fasciae latae transfer significantly enhances hip function and quality of life. Over an average follow-up period of 7.17 months, patients experienced notable improvements. This technique is an effective option for treating lateral hip pain due to tendinopathy.

Keywords: double-row technique; gluteus medius reconstruction; tendinopathy treatment.

Figure 1

The surgical sequence for gluteal reconstruction: (a) The greater trochanter was exposed, and the anatomy of the abductor tendon insertions was delineated. (b) The torn gluteus medius and minimus tendons were identified, debrided, and secured with traction sutures, preserving viable tissue. (c) Two VERSALOOP™ 2.5 mm (DePuy Synthes and Johnson & Johnson) anchors were placed in the lateral (green circle) and supero-posterior (blue circle) facets near the medial footprint edge. (d) A fascia latae autograft (round white dots) was harvested and placed over the defect and footprint. (e) One limb of each suture pair (4 pairs) was incorporated into two 4.75 mm PEEK anchors in the lateral row. (f) The sutures were sequentially tensioned before inserting the anchors to compress the graft-tendon unit against the footprint. Gmed = gluteus medius, Gmin = gluteus minimus, FLT = fascia latae tendon.