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.
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.
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.