Treatment of Abductor Deficiency Post Total Hip Arthroplasty Using Gluteus Maximus Transfer and Cortical Button Fixation.

Background and aims: Abductor deficiency in the setting of total hip arthroplasty (THA) can cause pain, poor function, and instability. Multiple treatment approaches exist for each stage of muscle and tendon disease. Transfer of a portion of gluteus maximus to the greater trochanter is a burgeoning procedure for irreparable gluteal deficiency. Described techniques for securing the flap to the trochanter can be compromised in the setting of bone loss and can contribute to bone loss themselves. This study aimed to describe the use of a polyethylene suture tape and cortical button for fixation of a gluteus maximus flap and provide early evidence for its equivalence to published techniques.

Methods: The surgical technique is described. A consecutive series of patients undergoing gluteus maximus transfer for abductor deficiency in the setting of total hip arthroplasty were assessed using visual analog scales (VAS) for pain, patient satisfaction, gait parameters, and magnetic resonance imaging (MRI) assessment of flap healing.

Results: There were five patients available for review at an average of 9 months post surgery. Mean VAS pain improved from 8 to 3. The majority would have the procedure performed again. Use of a gait aid improved in the patients that required one. All MRIs demonstrated graft incorporation.

Conclusions: Securing the transfer of the anterior third of gluteus maximus using polyethylene suture tape and cortical button suspensory fixation results in flap healing to the recipient site. Clinical results obtained in patients undergoing this modified technique are consistent with the published results, supporting its use.