Outcomes Following Primary Total Hip Arthroplasty With Concomitant Gluteus Medius Repair Using the Direct Anterior Approach.

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. 20XX;XX(X):xx-xx.].

[1]  David R. Maldonado,et al.  Intraoperative Classification System Yields Favorable Outcomes for Patients Treated Surgically for Greater Trochanteric Pain Syndrome. , 2021, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[2]  David R. Maldonado,et al.  Primary Robotic-Arm Assisted Total Hip Arthroplasty: An Analysis of 501 Hips With 44-Month Follow-up. , 2021, Orthopedics.

[3]  David R. Maldonado,et al.  Repair of Symptomatic Partial Gluteus Medius Tear During Total Hip Arthroplasty Through the Direct Anterior Approach , 2021, Arthroscopy techniques.

[4]  David R. Maldonado,et al.  Modern Suture Anchor Techniques for Gluteus Medius Tear Repair With Concomitant Total Hip Arthroplasty Using the Direct Anterior and Posterior Approaches. , 2021, Orthopedics.

[5]  David R. Maldonado,et al.  Asymptomatic Gluteal Tendinopathies Negatively Impact Outcomes of Total Hip Arthroplasty: A Propensity Score-Matched Study. , 2020, The Journal of arthroplasty.

[6]  David R. Maldonado,et 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 , 2020, Orthopaedic journal of sports medicine.

[7]  R. Westermann,et al.  Endoscopic Gluteus Medius Repair With an ITB-Sparing Versus ITB-Splitting Approach: A Systematic Review and Meta-analysis , 2020, Orthopaedic journal of sports medicine.

[8]  David R. Maldonado,et al.  Hip-Spine Syndrome: The Diagnostic Utility of Guided Intra-articular Hip Injections. , 2019, Orthopedics.

[9]  Leslie C. Yuen,et al.  Diagnostic accuracy of a new clinical test (resisted internal rotation) for detection of gluteus medius tears , 2019, Journal of hip preservation surgery.

[10]  David R. Maldonado,et al.  Direct anterior approach versus posterior approach in primary total hip replacement: comparison of minimum 2-year outcomes , 2019, Hip international : the journal of clinical and experimental research on hip pathology and therapy.

[11]  David R. Maldonado,et al.  Greater Trochanteric Pain Syndrome: An Intraoperative Endoscopic Classification System with Pearls to Surgical Techniques and Rehabilitation Protocols , 2019, Arthroscopy techniques.

[12]  P. Mertl,et al.  Does the direct anterior approach allow earlier recovery of walking following total hip arthroplasty? A randomized prospective trial using accelerometry. , 2019, Orthopaedics & traumatology, surgery & research : OTSR.

[13]  G. Erens,et al.  Current Trends in Clinical Practice for the Direct Anterior Approach Total Hip Arthroplasty. , 2019, The Journal of arthroplasty.

[14]  D. Delagrammaticas,et al.  Anterior versus posterior approach total hip arthroplasty: patient-reported and functional outcomes in the early postoperative period , 2019, Hip international : the journal of clinical and experimental research on hip pathology and therapy.

[15]  David R. Maldonado,et al.  The Modified Resisted Internal Rotation Test for Detection of Gluteal Tendon Tears , 2019, Arthroscopy techniques.

[16]  K. Kaneko,et al.  Posterior versus direct anterior approach in total hip arthroplasty: difference in patient-reported outcomes measured with the Forgotten Joint Score-12 , 2018, SICOT-J.

[17]  B. Domb,et al.  Knotless “Suture Staple” Technique for Endoscopic Partial Thickness Abductor Tendon Repair , 2018, Arthroscopy techniques.

[18]  B. Domb,et al.  Endoscopic Repair of Partial-Thickness Undersurface Tears of the Abductor Tendon: Clinical Outcomes With Minimum 2-Year Follow-up. , 2018, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[19]  F. Traina,et al.  Direct anterior approach versus posterolateral approach in total hip arthroplasty: effects on early post-operative rehabilitation period. , 2017, Journal of biological regulators and homeostatic agents.

[20]  L. Nordsletten,et al.  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 , 2015, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[21]  C. Jacobs,et al.  Comparison of Patient Function during the First Six Weeks after Direct Anterior or Posterior Total Hip Arthroplasty (THA): A Randomized Study. , 2015, The Journal of arthroplasty.

[22]  W. P. Barrett,et al.  Prospective randomized study of direct anterior vs postero-lateral approach for total hip arthroplasty. , 2013, The Journal of arthroplasty.

[23]  L. Biant,et al.  Abductor mechanism tears in primary total hip arthroplasty , 2012, Archives of Orthopaedic and Trauma Surgery.

[24]  P. Lachiewicz.  Abductor Tendon Tears of the Hip: Evaluation and Management , 2011, The Journal of the American Academy of Orthopaedic Surgeons.

[25]  S. Rajkumar,et al.  Results following Repair of Gluteus Medius Defects following Total Hip Arthroplasty , 2011, Hip international : the journal of clinical and experimental research on hip pathology and therapy.

[26]  P. Austin.  An Introduction to Propensity Score Methods for Reducing the Effects of Confounding in Observational Studies , 2011, Multivariate behavioral research.

[27]  I. Botser,et al.  Partial-thickness tears of the gluteus medius: rationale and technique for trans-tendinous endoscopic repair. , 2010, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[28]  V. Kavarthapu,et al.  Reproducibility and accuracy of templating uncemented THA with digital radiographic and digital TraumaCad templating software. , 2009, Orthopedics.

[29]  P. Hoffmeyer,et al.  Results of surgical repair of abductor avulsion after primary total hip arthroplasty. , 2008, The Journal of arthroplasty.