Tears of the hip abductors, of which the gluteus medius is the chief example, have become a newly recognised orthopaedic entity in recent years. There are many who hold that they are also the cause of the pain in many cases of persistent pain over the lateral aspect of the hip that we orthopaedic surgeons commonly regard as trochanteric bursitis. It appears that tears of the insertion of the gluteus medius are a finding both in people with a high level of sporting activity and, particularly at older ages, may also form part of the body's normal degenerative process.
There is extensive reference to such cases in the international literature, and many authors indeed tend to liken the condition to a tear of the rotator cuff of the shoulder (rotator cuff tear). The insertion of the gluteus medius at the hip does in fact have a good deal in common with the insertion of the rotator cuff at the shoulder, both in terms of function and in its anatomical characteristics.
The prevailing approach in orthopaedics to the management of pain over the lateral aspect of the hip (lateral hip pain), whether it is a matter of trochanteric bursitis, of tendinitis or tendinopathy, or of a partial tear of the insertion of the gluteus medius, consists of conservative treatment with analgesics and anti-inflammatory drugs, physiotherapy techniques, and injections of steroids or other agents.
In recent years, however, operative treatment of such cases has come to the fore, particularly in younger patients and above all in athletes. In this group of patients it has been observed that the cause of the pain is a partial tear of the tendon, the repair of which has been described using either an open or an arthroscopic technique. In both cases the repair is carried out using special bone anchors (anchors), which are placed in the femur and at the same time hold the gluteus medius tendon at its bony attachment.
A recent and interesting study published in the journal Arthroscopy in December 2017 presents a review of a series of patients (case series) covering 16 cases, with a follow-up of five years.
The authors presented their experience of partial or complete tears of the insertion of the gluteus medius with concomitant hip arthroscopy. The data collected covered the period from February 2009 to September 2011 and had been collected prospectively. Patients were included who underwent repair of the insertion of the gluteus medius with concomitant hip arthroscopy for the treatment of a tear of the labrum. All the patients had a minimum follow-up of five years and were assessed using the modified Harris Hip Score, Non-Arthritic Hip Score and Hip Outcome Score-Sports Specific Subscale hip rating scales, and a pain analogue scale for the hip (visual analog scale score). The international Hip Outcome Tool-12 (iHOT-12) was also used, at their final review. The patients who were excluded had at least one of the following criteria: the presence of osteoarthritis with a Tönnis grade greater than 2, a previous history of hip disorders, severe dysplasia, and being claimants for disability compensation.
There were 16 patients who met the inclusion criteria, 14 (87.5%) of whom had a minimum follow-up of five years, with a mean follow-up of 68.8 months (range, 60.1 to 79.6 months). The study group comprised 13 women (92.9%) and one man (7.1%) with a mean age at operation of 57.4 years (range 46.3 to 74.8 years). The scores on the rating scales improved as follows: for the modified Harris Hip Score, from 52.4 to 81.2 (p=0.004); for the Non-Arthritic Hip Score, from 48.0 to 82.5 (p=0.002); for the Hip Outcome Score-Sports Specific Subscale, from 30.1 to 66.4 (p<0.001); and for the visual analog scale score, from 6.2 to 2.6 (p=0.001). At the minimum follow-up of five years, the mean iHOT-12 score was 73.8 and the mean patient satisfaction score was 8.4. Survivorship was 92.9%, and one patient underwent total hip arthroplasty. There was no deterioration in the patients' outcomes or in their satisfaction between two and five years postoperatively. There were no clinical failures of the gluteus medius repair and no other complications.
The authors concluded that endoscopic gluteus medius repair with concomitant hip arthroscopy for tears of the labrum is a safe technique and shows favourable results in patients with a minimum follow-up of five years. The patients' outcomes were indeed as good at five years as they had been at two years postoperatively.
Source: Perets I, Mansor Y, Yuen LC, Chen AW, Chaharbakhshi EO, Domb BG. Endoscopic Gluteus Medius Repair With Concomitant Arthroscopy for Labral Tears: A Case Series With Minimum 5-Year Outcomes. Arthroscopy. 2017 Dec;33(12):2159-2167.