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Gluteus Maximus Muscle Transfer for Management of Abductor Deficiency of the Hip

March 01, 2019

Contributors: Miguel Brugiatti, MD; Ruddy Coaquira; Juan Carlos Gomez Hoyos, MD; William Henry Marquez, MD; Francisco Javier Monsalve, MD; Alvaro Vanegas-Gomez, MD; Bernardo Aguilera Sr, MD; Bernardo Aguilera Sr, MD

Abductor muscle deficiency of the hip joint can result in severe pain over the lateral aspect of hip, a limp, and hip joint instability. Abductor deficiency may occur after primary disruption of the abductor mechanism, secondary to avulsion of the greater trochanter or the abductor insertion during total hip arthroplasty, after surgical management of a hip fracture, after failed repair of the abductor tendon insertion to the greater trochanter, after resection of tumors affecting the hip abductors, and after osteolytic destruction of the proximal femoral bone stock in patients who undergo failed total hip arthroplasty. Various techniques have been used to reattach the abductor muscles to the greater trochanter. Direct transosseous repair and endoscopic repair techniques have been used in patients without myotendinous defects. Reconstruction techniques, such as vastus lateralis muscle transfer, gluteus maximus muscle transfer, use of Achilles tendon allograft, and use of extensor mechanism allograft, have been used in patients with myotendinous defects. Muscle transfers are advantageous for reconstructing deficient hip abductors because they, ideally, afford active abduction, contributing to improved gait. Reconstruction of deficient hip abductors with an allograft only fills the gap and restores the continuity of the abductor mechanism, acting as a tenodesis to stabilize the pelvis and reduce limp. This video shows transfer of the gluteus maximus muscle to the greater trochanter in a cadaver model and in a 60-year-old patient with gluteus medius insufficiency after intertrochanteric hip fracture. Gluteus maximus muscle transfer is an effective and safe salvage procedure for the management of abductor deficiency of the hip.

Results for "Adult Reconstruction"

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