Objective: Repair of a chronic rupture with a defect of the gluteus medius muscle with or without a total hip replacement. Improvement of gait and limping by functional stabilization of the pelvis. Reduction of pain in the region of the greater trochanter.
Indications: Chronic rupture with a defect of the gluteus medius.
Contraindications: Complete bony defect and absence of the greater trochanter and hip infection.
Operative technique: Lateral positioning of the patient. Longitudinal incision of 12-15 cm over the greater trochanter. Preparation to the fascia and longitudinal incision slightly dorsal to the greater trochanter. Preparation and mobilization of the ruptured parts of the gluteal muscles. Smoothening of the insertion of the gluteal muscle. Transosseus fixation of the ventral part of the ruptured gluteal muscles using fiber wires (Arthrex, Munich, Germany) with a Mason-Allen technique. Suturing of the mobilized posterior part of the ruptured gluteal muscle on the resutured ventral gluteal part. Securing of the readaptation by suturing a nonresorbable collagen patch (Zimmer, Winterthur, Switzerland) in a rhomboid direction with nonresorbable sutures (Ethibond, Ethicon, Norderstedt, Germany). Wound closure. POSTOPERATIVE TREATMENT: Prophylaxis of deep venous thrombosis. Early functional mobilization. Continuous increase of weight bearing over a period of 6 weeks and 6 weeks no adduction or active abduction.
Results: Ten patients (9 women, 1 man; age 73.4 ± 12.3 years) showed significant improvement of their symptoms after 1 year. All were pain free and did not need crutches anymore. Four could walk without any limping and in 6 slight limping was observed. The Harris Hip Score increased from 47.5 ± 9.5 points preoperative to 85.2 ± 7.6 points 1 year postoperative. Complications were not observed.