What is Open Gluteus Medius Repair?
Open gluteus medius repair is a surgical procedure employed for the treatment of gluteus medius tears.
A gluteus medius tear or rupture is a condition characterized by a severe strain of the gluteus medius muscle that results in a partial or complete rupture of the muscle. These tears are most commonly seen in runners and athletes involved in high-impact sports such as soccer and basketball and can also occur due to traumatic injury or degenerative conditions such as tendinopathy (chronic inflammation of the gluteus medius tendon) or wear and tear.
Anatomy of the Gluteus Medius Muscle
The gluteus medius is one of the major muscles of the hip, essential for the movement of the lower body and keeping the pelvis level during ambulation. The gluteus medius muscle arises from the top of the pelvic bone and attaches to the outer side of the thighbone or femur at the greater trochanter by the gluteus medius tendon. The muscle functions as a hip abductor, controlling the side-to-side movement of the hip and providing stabilization to the joint.
Preparation for Open Gluteus Medius Repair
Preoperative preparation for open gluteus medius repair will involve the following steps:
- A thorough examination by your doctor is performed to check for any medical issues that need to be addressed prior to surgery.
- Depending on your medical history, social history, and age, you may need to undergo tests such as blood work and imaging to help detect any abnormalities that could threaten the safety of the procedure.
- You will be asked if you have allergies to medications, anesthesia, or latex.
- You should inform your doctor of any medications, vitamins, or supplements that you are taking.
- You should refrain from medications or supplements such as blood thinners, aspirin, or anti-inflammatory medicines for 1 to 2 weeks prior to surgery.
- You should not consume any solids or liquids at least 8 hours prior to surgery.
- Arrange for someone to drive you home after surgery.
- A written consent will be obtained from you after the surgical procedure has been explained in detail.
Procedure for Open Gluteus Medius Repair
Open gluteus medius repair surgery is mainly recommended to repair a complete, full-thickness gluteus medius tear that has not responded to conservative treatment. The goal of the surgery is to help restore the strength and function of the gluteus medius muscle and hip/pelvis function.
In general, open gluteus medius repair surgery will involve the following steps:
- You will be lying on your back (supine position) on the operating table.
- You will be administered either general or regional anesthesia.
- A 6- to 8-inch long incision is made directly over the gluteus medius tear around the hip joint area.
- The hip bursa will be removed, and the ruptured gluteus medius tendons will be identified.
- Suture anchors will be positioned in the greater trochanter and passed through the ruptured gluteus medius tendons to reunite tissues split up by traumatic injury or degeneration to their native anatomic location on the thigh bone.
- The incision is closed through the deep soft tissues and the skin with dissolvable sutures, and a sterile dressing is applied.
Postoperative Care and Instructions
In general, postoperative care instructions and recovery after open gluteus medius repair will involve the following steps:
- You will be transferred to the recovery area where your nurse will closely observe you for any allergic/anesthetic reactions and monitor your vital signs as you recover.
- You may need to stay in the hospital for 2 to 3 days before discharge to home.
- You may notice some pain, swelling, and discomfort in the hip area. Pain and anti-inflammatory medications are provided as needed.
- You will be placed on assistive devices such as crutches with instructions on restricted weight-bearing for a specified period of time. You are encouraged to walk with assistance as frequently as possible to prevent blood clots.
- Keep the surgical site clean and dry. Instructions on surgical site care and bathing will be provided.
- Refrain from smoking as it can negatively affect the healing process.
- Refrain from strenuous activities for the first few months and lifting heavy weights for at least 6 months. Gradual increase in activities over a period of time is recommended.
- An individualized physical therapy protocol will be designed to help strengthen hip muscles and optimize hip function.
- Most patients are able to resume their normal activities in 3 to 4 weeks after surgery; however, return to sports may take at least 6 months or longer.
- Refrain from driving until you are fully fit and receive your doctor’s consent.
- A periodic follow-up appointment will be scheduled to monitor your progress.
Risks and Complications
Open gluteus medius repair is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as the following:
- Postoperative pain
- Damage to nerves and vessels
- Thromboembolism or blood clots
- Anesthetic reactions