Preoperative asymptomatic gluteus medius and minimus pathology can lead to poorer total hip arthroplasty outcomes, a new study finds.
Gluteus Medius, Minimus Pathology Equals Poorer THA Outcomes
1 min read Premium comments
#totalhiparthroplastySecondary#asymptomatictendinopathy#gluteusmediusandminimuspathology
In the study, “Asymptomatic Gluteal Tendinopathies Negatively Impact Outcomes of Total Hip Arthroplasty: A Propensity Score-Matched Study” published on July 29, 2020 in the Journal of Arthroplasty, researchers compared the outcomes after total hip arthroplasty in patients with preoperative asymptomatic gluteus medius and minimus (GMM) pathology versus a control group with no GMM pathology.
Asymptomatic gluteus medius and minimus pathology was defined as the presence of gluteal tendinopathy diagnosed by MRI without certain clinical symptoms including Trendelenburg gait or test, abductor weakness, and lateral thigh tenderness.
The retrospective publication review collected data on 100 patients who had total hip arthroplasty (THA) for osteoarthritis between August 2012 and March 2018. Fifty of them had GMM pathology and the other 50 did not.
Gluteus medius and minimus tears are common in both middle-age males and females but are often misdiagnosed until found during a fracture fixation or hip arthroplasty.
The two-year patient-reported outcomes included Harris Hip Score, Forgotten Joint Score, pain and satisfaction.
Overall, patients with asymptomatic gluteus medius and minimus pathology demonstrated worse scores: 2-year Harris Hip Score (86.24 vs. 92.39, p = .04), VAS for pain (1.82 vs. 0.98, p = .05), and patient satisfaction (7.69 vs. 9.16, p = .002).
The gluteus medius and minimus pathology group also had higher rates of lateral hip pain postoperatively. Four of them needed a revision THA. In the control group, however only two patients needed a revision THA.
The researchers wrote, “In patients undergoing THA for osteoarthritis, those with asymptomatic gluteus medius and minimus pathology experience inferior 2-year postoperative patient-reported outcomes compared to a matched group.”
They added, “This finding should raise awareness surrounding this important pathology’s negative impact on surgical outcomes, thus warranting increased vigilance, and possibly justifying concomitant treatment, even in cases of asymptomatic gluteus medius and minimus tears.”
React:
Discussion
This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
Join the conversation
Orthopedic professionals are discussing this. Sign in and upgrade to read every comment and add your voice.