[Surgical refixation of gluteal tendon tears by mini-open double-row technique]

Recreational activity after open hip abductor repair

BACKGROUND

Hip abductor tear (HAT) is an increasingly diagnosed cause of refractory lateral hip pain and dysfunction, affecting 10-25% of the general population.

PURPOSE

(1) to determine the rate of return to activity and to assess the physical and recreational activity of patients undergoing open hip abductor repair (oHATr) and (2) to describe the modification or initiation of new sports disciplines.

STUDY DESIGN

Case series; Level of evidence, 4.

METHODS

A total of 28 patients (29 hips) who underwent an oHATr were prospectively analyzed at a midterm follow-up of 3.5 (range 2-5) years. The sports and recreational activity levels, as well as type of sports practiced before and after surgery, and The Veterans RAND 12 Item Health Survey (VR-12) were assessed via questionnaire.

RESULTS

At the final follow-up, all patients were active in sports after surgery. The duration and frequency of sports activities showed a slight decrease (48-42 min per week and 3.2-2.9 sessions per week, respectively) (p = 0.412 and 0.135, respectively). The VR-12 had a score of 45 (13.12-63.18) points for the physical component and 41 (32-53.8) points for the mental component. 100% of the patients would undergo the surgery again. 95% of patients were satisfied with the overall results of the surgical outcome, with 98% satisfied with their hip pain relief and ability to undertake daily and work activities. Moreover, 94% were satisfied with their ability to return to recreational activities. The failure rate in our cohort was approximately 14%.

CONCLUSION

All patients who underwent an oHATr were able to return at least to one type of sport. This cohort was highly satisfied with their sports involvement and recreational activity achievement. In addition, 88% of patients reported that oHATr improved sports activity. There was a shift from higher to lower impact sports. Furthermore, just 3 hips present a retear after surgery.

Open Hip Abductor Repair Hitting the Sack-Abductor Tendon Repair Significantly Improves Sleep Quality

PURPOSE

To (1) describe the prevalence of abnormal sleep quality in patients with hip abductor tears (HAT), to (2) determine whether sleep quality improves after open HAT repair, and to (3) to report clinical short-term outcomes in patients undergoing open HAT repair.

METHODS

The data of 28 patients (29 hips) who underwant open HAT repair were prospectively analyzed at midterm follow-up. The Pittsburgh Sleep Quality Index (PSQI), modified Harris Hip Score (mHHS), the University of California, Los Angeles activity scale (UCLA), and Visual Analog Scale (VAS) for pain were determined via questionnaire. Paired t-tests were applied to compare preoperative and post-operative Patient-reported Outcome Measures (PROMs). Logistic regression was performed to determine the association between PSQI improvement achievement and demographic variables (laterality, sex, age, body-mass-index (BMI), and preoperative mHHS). The minimal clinically important difference (MCID) was calculated for the mHHS.

RESULTS

A total of 28 patients were included. Four patients (14.3%) suffered post-operative complications after open HAT repair. The predominance of patients was female (77.4%), with a mean age of 60 ± 13 years. The average follow-up was 30.35 ± 16.62 months. Preoperatively, 27 (96.4%) patients experienced poor sleep quality (PSQI > 5); at follow-up, 7 (25%) patients experienced poor sleep quality. Univariate logistical regression analysis demonstrated no significant association between preoperative demographic data and achieving postoperative PSQI < 5. The MCID of mHHS was calculated to be 12.5. Overall, 90% of patients achieved MCID for mHHS.

CONCLUSION

Preoperative sleep quality was impaired in 96.4% of HAT patients (PSQI > 5). However, these patients showed an improvement in sleep disturbances after open HAT repair in the early postoperative period. Ninety percent of patients showed significant improvements in mHHS and achieved the corresponding MCID.

LEVEL OF EVIDENCE

Case series; Level IV.

[Avulsion injuries of the gluteus medius and gluteus minimus muscles]

Avulsion injuries of the gluteus medius and gluteus minimus muscles represent a diagnostic and therapeutic challenge. Such injuries are rarely to be expected in high-energy trauma. Degenerative damage or iatrogenic injuries in the context of hip surgery are more frequently identified as the cause. Clinically, in addition to lateral hip pain, limping is an important finding and depends on the extent of the tendon damage. In addition to the medical history and clinical examination, imaging by means of sonography and, above all, magnetic resonance imaging (MRI, possibly with artifact-reduced sequences in the presence of an endoprosthesis) are diagnostically groundbreaking. Therapeutically, a stepwise approach is indicated according to the extent of rupture and quality of the gluteal tendon and muscle tissues. Specific conservative training regimens, mini-open/endoscopic anatomic reconstruction techniques in cases of gluteal muscle integrity and muscle transfer techniques as salvage option with chronic mass ruptures are available. The common goal is the restoration of everyday occupational and private activities to regain the quality of life.

[Gluteal insufficiency]

Gluteal insufficiency or hip abductor mechanism deficiency mainly following (revision) total hip replacement is associated with highly painful complaints and severe suffering of patients. It represents a great diagnostic and therapeutic challenge. Differentiated conservative treatment pathways, open surgical and endoscopic anatomic repair techniques with intact gluteal musculature and muscle transfer are available as salvage procedures for chronic not anatomically reconstructable mass ruptures. A stepwise diagnostic and therapeutic approach is required for restoration of the quality of life and painless or almost painless mobility of affected patients in occupation and daily life.