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Resident PGY 5
Henry Ford Macomb
Introduction: Lateral approach total hip arthroplasty (THA) accounts for 12% of the total hip reconstructions performed annually. Approximately 4.4% of these patients experience postoperative rupture of the gluteus medius (routinely take down and repaired during the surgery), resulting in loss of abduction and a contralateral hip drop with a Trendelenburg gait. While functional muscle transfer has been proposed for use at the time of implant revision surgery, to our knowledge, no report exists of dynamic repair in patients with a functioning implant and early muscle rupture. Case: A 47-year-old female presented to clinic with MRI proven rupture of the gluteus medius and failed secondary surgical repair. The patient noted significant discomfort with activities of daily living. A review of the literature was performed, and joint decision-making was utilized to consent for a superior gluteus maximus transfer. An interdisciplinary team (plastic and orthopedic surgery) performed the surgery with modifications to a technique previously described. Results: Surgery was performed in 2 hours and 49 minutes. Postoperative course was uneventful. At 4 months post-op, the patient has a significant increase in abduction strength. The patient is able to stand without hip drop and continues extensive physical therapy for balance and gait given the 2 years of atrophy and maladaptation. The patient reports improvement in quality of life and physical therapy notes indicate improvement across all gait, stance, and strength studies. Conclusion: The superior gluteus maximus muscle transfer for gluteus medius ruptures a viable option in patients with Trendelenburg gait, warranting further clinical study.
Nelson, Karen; Martinez, Melissa; Scott, Fremont; Goldman, JJ; and Chaiyasate, K, "Gluteus Maximus Transfer for Trendelenburg Gait Following Total Hip Arthroplasty" (2019). Case Reports. 93.