Deficiency in the gluteus medius and minimus abductor muscles is a well-recognised cause of hip pain and considerable disability. These patients present a management challenge, with no established consensus for surgical intervention. Whiteside in 2012 described a surgical technique for gluteus maximus tendon transfer, with successful outcomes reported. This study is the largest known case series to date of patients undergoing gluteus maximus tendon transfer with clinical and patient reported outcomes measured.

13 consecutive patients were included in the study. All patients had clinical evidence of abductor dysfunction together with MRI evidence of gluteal atrophy and fat infiltration. All patients underwent gluteus maximus transfer with surgery performed according to the procedure described by Whiteside. Patients were followed up with both clinical assessment and patient questionnaires conducted.

Mean age was 69 (range 54–82) with 9 patients (69%) having previous Hardinge approach to the affected hip. 6 patients (46%) reported they were satisfied overall with the procedure and 5 patients (38%) were unsatisfied. 7 patients (54%) had improvements in visual analogue scale of pain and 5 patients (54%) reported overall improvements in function. Mean Oxford Hip Score on follow up was 20/48 (range 5–48) and trendelenberg test was positive in 11 patients (85%). No differentiating variable could be identified between patients with positive and negative outcomes (Assessed Variables: Age, sex, BMI, aetiology and gluteus maximus muscle thickness).

Clinical outcomes were varied following gluteus maximus tendon transfer for chronic hip abductor dysfunction. Results are considerably less promising than pre-existing studies would suggest.

Introduction

Direct lateral approaches to the hip require detachment and repair of the anterior part of the gluteus medius and minimus tendon attachments. Limping may occur postoperatively due to nerve injury or failure of muscle re-attachment. The aim of this study was to assess the integrity of abductor muscle repairs using a braided wire suture marker.

Goal. The goal of this prospective, non-randomized study is to compare functional and life-quality changes in primary total hip replacement (THR) with minimally invasive anterior (MIA) and direct lateral (DL) approach in six months follow-up. Materials and Methods. Sixty (30 MIA and 30 DL) consecutive patients underwent primary THR were operated by the same senior surgeon. Patients completed functional and life-quality scores (Oxford Hip Score, Harris Hip Score, EQ-5D) before operation and four times (2 and 6 weeks, 3 and 6 months) after THR. Physical examination was taken all times. 15–15 patients underwent MRI examination to adjudge status of abductor muscles. The average patient age was approximately equal in both group. Results. The average OHS values were 13,4; 27,5; 40,9; 45,3; 47,5 in MIA and 15,3; 25,3; 39,7; 43,8; 45 in DL, the average HHS values 43,1; 68,7; 85,3; 91,9; 96,7 in MIA and 43; 58,2; 81,5; 90,2; 93,9 in DL, the average EQ-VAS 41,1; 72,5; 85,9; 87,8; 92,4 in MIA and 55,6; 67,8; 80,6; 84; 91,3 in DL consecutively. In MIA group both functional and life-quality scores showed better results, but for the 3rd postoperative month increases were approximately equal. Abductor muscle strength was significantly greater in MIA group in this period. In the 6th postoperative week Trendelenburg-sign was detected in 24 cases (80%) in DL and in 2 cases (6,7%) in MIA group, but in MIA patients were greater trochanter fractures, which had gone healing and limping was not detected 3 months after surgery. 3 months after surgery Trendelenburg-sign was detected in 2 cases in DL group. In follow-up period residual trochanteric pain was detected in 3 cases in DL but none in MIA group. Two weeks after THR climbing a flight of stairs was normal and public transport could be used by 80% of patients in MIA group. Distance walk was unlimited, support had not needed, daily activities were easy. There were 7 operative complications in MIA group, including 2 greater trochanter fracture, 1 haematoma and 4 transient lateral femoral cutaneous nerve palsy, which showed change for the better after 6 months. Postoperative hip dislocation was not detected. In DL group MRI represented fatty infiltration and atrophy of abductor muscles in most cases. Conclusions. Besides the fact that our learning curve may influence the results. It seems that earlier mobilisation and faster postoperative recovery can be achieved by MIA approach, which have many financial and social benefits. It preserves muscles and tendons, which probably can influence the long-term results. By preventing abductor muscles can assure better gait pattern. Of course additional long-term studies are needed

We have treated 14 patients (15 fractures) with nonunion of an intra-articular fracture of the body of the calcaneum. The mean follow-up was six years (2 to 8.5). A total of 14 fractures (93%) had initially been treated operatively with 12 (86%) having non-anatomical reductions. Four feet (27%) had concomitant osteomyelitis. Of the nonunions, 14 (93%) went on to eventual union after an average of two reconstructive procedures. All underwent bone grafting of the nonunion. The eventual outcome was a subtalar arthrodesis in ten (67%) cases, a triple arthrodesis in four (27%) and a nonunion in one (6%). Three patients had a wound dehiscence; all required a local rotation flap. The mean American Orthopaedic Foot and Ankle Society score at latest follow-up was 69, and the mean Visual analogue scale was 3. Of those who were initially employed, 82% (9 of 11) eventually returned to work. We present an algorithm for the treatment of calcaneal nonunion, and conclude that despite a relatively high rate of complication, this complex surgery has a high union rate and a good functional outcome.