Skip to main content
Orthopedics, 2023;46(1):39–46
Cite this articlePublished Online:https://doi.org/10.3928/01477447-20221003-09Cited by:2

Abstract

Outcomes following total hip arthroplasty (THA) with concomitant gluteus medius (GM) repair using the direct anterior approach (DAA) are scarce. The primary purpose of this study was to report patient-reported outcome measures (PROMs) with 2-year follow-up of patients with osteoarthritis and GM tear who underwent primary THA and GM repair through the DAA. The secondary purpose was to compare these outcomes with a benchmark propensity-matched control group who underwent a DAA THA without GM tear. Patients were eligible if they received a primary THA and GM repair via the DAA between January 2015 and October 2018 and had baseline PROMs with 2-year follow-up. Patients were excluded if they had workers' compensation or were unwilling to participate. PROM subanalysis was performed between patients and a propensity-matched control group with DAA THA without GM tear. Fourteen patients were included in the study, all of whom were female. Significant improvement for all PROMs and high rate of achieving the minimal clinically important difference (MCID) at 2-year follow-up were reported. All patients were propensity-matched to 28 patients for sex, age, and body mass index. Preoperative PROMs between groups were similar, and both groups reported comparable improvement, satisfaction, and MCID achievement at 2-year follow-up. Primary THA with concomitant GM repair using the DAA yielded good functional outcomes and a high rate of MCID achievement at 2-year follow-up. Based on these results, the DAA can be used safely to address symptomatic GM tears during THA. Furthermore, these outcomes were comparable to a propensity-matched control group without GM tear. [Orthopedics. 2023;46(1):39–46.]

  • 1.Maldonado DR, Annin S, Chen JWet al.. Full-thickness gluteus medius tears with or without concomitant hip arthroscopy: minimum 2-year outcomes using an open approach and contemporary tendon repair techniques. Orthop J Sports Med. 2020; 8(7):2325967120929330. 10.1177/2325967120929330 PMID:32699803

    > Crossref MedlineGoogle Scholar
  • 2.Parker EA, Meyer AM, Laskovski JR, Westermann RW. Endoscopic gluteus medius repair with an ITB-sparing versus ITB-splitting approach: a systematic review and meta-analysis. Orthop J Sports Med. 2020; 8(5):2325967120922196. 10.1177/2325967120922196 PMID:32548182

    > Crossref MedlineGoogle Scholar
  • 3.Whiteside LA, Roy ME. Incidence and treatment of abductor deficiency during total hip arthroplasty using the posterior approach: repair with direct suture technique and gluteus maximus flap transfer. Bone Joint J. 2019; 101(suppl B):116–122. 10.1302/0301-620X.101B6.BJJ-2018-1511.R1 PMID:31146555

    > Crossref MedlineGoogle Scholar
  • 4.Rosinsky PJ, Bheem R, Meghpara MBet al.. Asymptomatic gluteal tendinopathies negatively impact outcomes of total hip arthroplasty: a propensity score-matched study. J Arthroplasty. 2021; 36(1):242–249. 10.1016/j.arth.2020.07.063 PMID:32828621

    > Crossref MedlineGoogle Scholar
  • 5.Patel NN, Shah JA, Erens GA. Current trends in clinical practice for the direct anterior approach total hip arthroplasty. J Arthroplasty. 2019; 34(9):1987–1993. 10.1016/j.arth.2019.04.025 PMID:31076194

    > Crossref MedlineGoogle Scholar
  • 6.Christensen CP, Jacobs CA. Comparison of patient function during the first six weeks after direct anterior or posterior total hip arthroplasty (THA): a randomized study. J Arthroplasty. 2015; 30(suppl 9):94–97. 10.1016/j.arth.2014.12.038 PMID:26096071

    > Crossref MedlineGoogle Scholar
  • 7.Maldonado DR, Laseter JR, Kyin C, Lall AC, Domb BG. Direct anterior approach in total hip arthroplasty leads to superior outcomes at 3-month follow-up when compared with the posterior approach: a matched study using propensity score analysis. J Am Acad Orthop Surg Glob Res Rev. 2019; 3(12):e19.00118. 10.5435/JAAOSGlobal-D-19-00118 PMID:32072128

    > Crossref MedlineGoogle Scholar
  • 8.Maldonado DR, Kyin C, Diulus SCet al.. Modern suture anchor techniques for gluteus medius tear repair with concomitant total hip arthroplasty using the direct anterior and posterior approaches. Orthopedics. 2021; 44(5):e653–e660. doi:10.3928/01477447-20210817-05 PMID:34590946

    > LinkGoogle Scholar
  • 9.Lall AC, Schwarzman GR, Battaglia MR, Chen SL, Maldonado DR, Domb BG. Greater trochanteric pain syndrome: an intraoperative endoscopic classification system with pearls to surgical techniques and rehabilitation protocols. Arthrosc Tech. 2019; 8(8):e889–e903. 10.1016/j.eats.2019.04.004 PMID:31700784

    > Crossref MedlineGoogle Scholar
  • 10.Maldonado DR, Diulus SC, Meghpara MBet al.. Repair of symptomatic partial gluteus medius tear during total hip arthroplasty through the direct anterior approach. Arthrosc Tech. 2021; 10(2):e575–e580. 10.1016/j.eats.2020.10.043 PMID:33680795

    > Crossref MedlineGoogle Scholar
  • 11.Maldonado DR, Annin S, Chen JWet al.. Combined transfer of the gluteus maximus and tensor fasciae latae for irreparable gluteus medius tear using contemporary techniques: short-term outcomes. JBJS Open Access. 2020; 5(4):e20.00085. 10.2106/JBJS.OA.20.00085 PMID:33376925

    > Crossref MedlineGoogle Scholar
  • 12.Ortiz-Declet V, Chen AW, Maldonado DR, Yuen LC, Mu B, Domb BG. Diagnostic accuracy of a new clinical test (resisted internal rotation) for detection of gluteus medius tears. J Hip Preserv Surg. 2019; 6(4):398–405. 10.1093/jhps/hnz046

    > Crossref MedlineGoogle Scholar
  • 13.Walker-Santiago R, Ortiz-Declet V, Maldonado DR, Wojnowski NM, Domb BG. The modified resisted internal rotation test for detection of gluteal tendon tears. Arthrosc Tech. 2019; 8(3):e331–e334. 10.1016/j.eats.2018.11.006 PMID:31019887

    > Crossref MedlineGoogle Scholar
  • 14.Maldonado DR, Mu BH, Ornelas Jet al.. Hip-spine syndrome: the diagnostic utility of guided intra-articular hip injections. Orthopedics. 2020; 43(2):e65–e71. 10.3928/01477447-20191223-05 PMID:31881085

    > LinkGoogle Scholar
  • 15.Annin S, Lall AC, Meghpara MBet al.. Intraoperative classification system yields favorable outcomes for patients treated surgically for greater trochanteric pain syndrome. Arthroscopy. 2021; 37(7):2123–2136. 10.1016/j.arthro.2021.01.058 PMID:33581305

    > Crossref MedlineGoogle Scholar
  • 16.Kumar PGA, Kirmani SJ, Humberg H, Kavarthapu V, Li P. Reproducibility and accuracy of templating uncemented THA with digital radiographic and digital TraumaCad templating software. Orthopedics. 2009; 32(11):815. 10.3928/01477447-20090922-08 PMID:19902895

    > LinkGoogle Scholar
  • 17.Maldonado DR, Go CC, Kyin Cet al.. Robotic arm-assisted total hip arthroplasty is more cost-effective than manual total hip arthroplasty: a Markov model analysis. J Am Acad Orthop Surg. 2021; 29(4):e168–e177.

    > Crossref MedlineGoogle Scholar
  • 18.Domb BG, Chen JW, Kyin Cet al.. Primary robotic-arm assisted total hip arthroplasty: an analysis of 501 hips with 44-month follow-up. Orthopedics. 2021; 44(2):70–76. 10.3928/01477447-20210201-01

    > LinkGoogle Scholar
  • 19.Domb BG, Chen JW, Lall AC, Perets I, Maldonado DR. Minimum 5-year outcomes of robotic-assisted primary total hip arthroplasty with a nested comparison against manual primary total hip arthroplasty: a propensity score-matched study. J Am Acad Orthop Surg. 2020; 28(20):847–856. 10.5435/JAAOS-D-19-00328 PMID:32109923

    > Crossref MedlineGoogle Scholar
  • 20.Post ZD, Orozco F, Diaz-Ledezma C, Hozack WJ, Ong A. Direct anterior approach for total hip arthroplasty: indications, technique, and results. J Am Acad Orthop Surg. 2014; 22(9):595–603. 10.5435/JAAOS-22-09-595 PMID:25157041

    > Crossref MedlineGoogle Scholar
  • 21.Maldonado DR, Kyin C, Walker-Santiago Ret al.. Direct anterior approach versus posterior approach in primary total hip replacement: comparison of minimum 2-year outcomes. Hip Int. 2021. 10.1177/1120700019881937

    > CrossrefGoogle Scholar
  • 22.Tsutsumi M, Nimura A, Akita K. The gluteus medius tendon and its insertion sites: an anatomical study with possible implications for gluteus medius tears. J Bone Joint Surg Am. 2019; 101(2):177–184. 10.2106/JBJS.18.00602. PMID: 30653048

    > Crossref MedlineGoogle Scholar
  • 23.Domb BG, Nasser RM, Botser IB. Partial-thickness tears of the gluteus medius: rationale and technique for trans-tendinous endoscopic repair. Arthroscopy. 2010; 26(12):1697–1705. 10.1016/j.arthro.2010.06.002 PMID:20951538

    > Crossref MedlineGoogle Scholar
  • 24.Hartigan DE, Perets I, Ho SW, Walsh JP, Yuen LC, Domb BG. Endoscopic repair of partial-thickness undersurface tears of the abductor tendon: clinical outcomes with minimum 2-year follow-up. Arthroscopy. 2018; 34(4):1193–1199. 10.1016/j.arthro.2017.10.022 PMID:29305287

    > Crossref MedlineGoogle Scholar
  • 25.Hartigan DE, Mansor Y, Perets I, Walsh JP, Mohr MR, Domb BG. Knotless “suture staple” technique for endoscopic partial thickness abductor tendon repair. Arthrosc Tech. 2018; 7(10):e975–e980. 10.1016/j.eats.2018.06.002 PMID:30666291

    > Crossref MedlineGoogle Scholar
  • 26.Norman GR, Sloan JA, Wyrwich KW. Interpretation of changes in health-related quality of life: the remarkable universality of half a standard deviation. Med Care. 2003; 41(5):582–592. 10.1097/01.MLR.0000062554.74615.4C PMID:12719681

    > Crossref MedlineGoogle Scholar
  • 27.Austin PC. An introduction to propensity score methods for reducing the effects of confounding in observational studies. Multivariate Behav Res. 2011; 46(3):399–424. 10.1080/00273171.2011.568786 PMID:21818162

    > Crossref MedlineGoogle Scholar
  • 28.Lübbeke A, Kampfen S, Stern R, Hoffmeyer P. Results of surgical repair of abductor avulsion after primary total hip arthroplasty. J Arthroplasty. 2008; 23(5):694–698. 10.1016/j.arth.2007.08.018 PMID:18534495

    > Crossref MedlineGoogle Scholar
  • 29.Rajkumar S, Singer GC, Jones JR. Results following repair of gluteus medius defects following total hip arthroplasty. Hip Int. 2011; 21(3):293–298. 10.5301/hip.2011.8400 PMID:21698577

    > Crossref MedlineGoogle Scholar
  • 30.Martusiewicz A, Delagrammaticas D, Harold RE, Bhatt S, Beal MD, Manning DW. Anterior versus posterior approach total hip arthroplasty: patient-reported and functional outcomes in the early postoperative period. Hip Int. 2020; 30(6):695–702. 10.1177/1120700019881413 PMID:31588801

    > Crossref MedlineGoogle Scholar
  • 31.Bon G, Kacem EB, Lepretre PMet al.. Does the direct anterior approach allow earlier recovery of walking following total hip arthroplasty? A randomized prospective trial using accelerometry. Orthop Traumatol Surg Res. 2019; 105(3):445–452. 10.1016/j.otsr.2019.02.008 PMID:30853454

    > Crossref MedlineGoogle Scholar
  • 32.Barrett WP, Turner SE, Leopold JP. Prospective randomized study of direct anterior vs postero-lateral approach for total hip arthroplasty. J Arthroplasty. 2013; 28(9):1634–1638. 10.1016/j.arth.2013.01.034 PMID:23523485

    > Crossref MedlineGoogle Scholar
  • 33.Faldini C, Perna F, Mazzotti Aet al.. Direct anterior approach versus posterolateral approach in total hip arthroplasty: effects on early post-operative rehabilitation period. J Biol Regul Homeost Agents. 2017; 31(4 suppl 1):75–81. PMID:29185307

    > MedlineGoogle Scholar
  • 34.Meermans G, Konan S, Das R, Volpin A, Haddad FS. The direct anterior approach in total hip arthroplasty: a systematic review of the literature. Bone Joint J. 2017; 99-B(6):732–740. 10.1302/0301-620X.99B6.38053 PMID:28566391

    > Crossref MedlineGoogle Scholar
  • 35.Mjaaland KE, Kivle K, Svenningsen S, Pripp AH, Nordsletten L. Comparison of markers for muscle damage, inflammation, and pain using minimally invasive direct anterior versus direct lateral approach in total hip arthroplasty: a prospective, randomized, controlled trial. J Orthop Res. 2015; 33(9):1305–1310. 10.1002/jor.22911 PMID:25877694

    > Crossref MedlineGoogle Scholar
  • 36.Ozaki Y, Baba T, Homma Yet al.. Posterior versus direct anterior approach in total hip arthroplasty: difference in patient-reported outcomes measured with the Forgotten Joint Score-12. SICOT J. 2018; 4:54. 10.1051/sicotj/2018051 PMID:30480545

    > Crossref MedlineGoogle Scholar
  • 37.Odak S, Ivory J. Management of abductor mechanism deficiency following total hip replacement. Bone Joint J. 2013; 95-B(3):343–347. 10.1302/0301-620X.95B3.31098 PMID:23450018

    > Crossref MedlineGoogle Scholar
  • 38.Lachiewicz PF. Abductor tendon tears of the hip: evaluation and management. J Am Acad Orthop Surg. 2011; 19(7):385–391. 10.5435/00124635-201107000-00001 PMID:21724917

    > Crossref MedlineGoogle Scholar
  • 39.Hendry J, Biant LC, Breusch SJ. Abductor mechanism tears in primary total hip arthroplasty. Arch Orthop Trauma Surg. 2012; 132(11):1619–1623. 10.1007/s00402-012-1573-9 PMID:22763863

    > Crossref MedlineGoogle Scholar
  • 40.Pirruccio K, Evangelista PJ, Haw J, Goldberg T, Sheth NP. Safely implementing the direct anterior total hip arthroplasty: a methodological approach to minimizing the learning curve. J Am Acad Orthop Surg. 2020; 28(22):930–936. 10.5435/JAAOS-D-19-00752 PMID:32015249

    > Crossref MedlineGoogle Scholar

We use cookies on this site to enhance your user experience. For a complete overview of all the cookies used, please see our privacy policy.

×