Assessment of Association Between Spino-Pelvic Parameters and Outcomes Following Gluteus Medius Repair

doi:10.1016/j.arthro.2018.10.147

Arthroscopy: The Journal of Arthroscopic & Related Surgery

Volume 35, Issue 4, April 2019, Pages 1092-1098

https://doi.org/10.1016/j.arthro.2018.10.147 Get rights and content

Purpose

To evaluate postoperative coronal/sagittal spinal plane and spinopelvic parameters in patients undergoing gluteus medius repair and to identify associations between outcomes and the aforementioned spinopelvic variables.

Methods

Patients who underwent gluteus medius/minimus repair by a single surgeon between January 20, 2012, and November 25, 2015, were retrospectively identified from a prospectively collected database. Radiographic measurements included Cobb angle, lumbar lordosis, sagittal vertical axis (SVA), pelvic tilt, sacral slope, and pelvic incidence. Patient-reported outcomes (PROs) were obtained at baseline and a minimum of 22 months after surgery. Bivariate correlation determined effects of spinopelvic measurements on PROs. Scoliosis and nonscoliosis groups were compared using independent samples t-test, and multivariate analysis determined whether the preoperative variables affected outcomes.

Results

Thirty-eight (80.9%) of 47 consecutive patients were radiographically evaluated with a scoliosis series. All patients demonstrated significant improvements in all PROs and pain (P < .001 for all), as well as at an average 28.2 ± 7.8 (range, 22-51) months after surgery. There were significant negative relationships between SVA and Hip Outcome Score–Activities of Daily Living (r = −0.405, P = .026) and Hip Outcome Score–Sports Specific (r = −0.492, P = .011) scores. Patients with a positive SVA (>0 cm) had significantly worse patient-reported outcomes than their counterparts with negative (≤0 cm) SVA. Also, patients with positive sagittal plane deformity (SVA >5 cm) had significantly worse HOS-SS than patients without positive sagittal plane deformity (SVA <5 cm) (47.0 ± 35.3, 73.2 ± 24.0; P = .04). Independent sample t-testing for the patients with scoliosis (n = 18) versus no scoliosis (n = 20) demonstrates a significantly worse postoperative International Hip Outcome Tool (short version) score in the patients with scoliosis (77.4 ± 15.1, 53.8 ± 37.1; P = .043).

Conclusions

Patients with scoliosis presented with lower rates of symptom improvement and ability to return to an active lifestyle in patients with hip disorders. In addition, patients with positive sagittal plane deformity experienced lower hip-related sport-specific outcome scores. Although the direct relationship between the spine and the hip in patients after gluteus medius/minimus repair remains unclear, this study shows an association between these postoperative outcomes and spinopelvic parameters.

Level of Evidence

Level IV, case series.

Section snippets

Patient Selection

Following institutional review board approval (no. 16091507-IRB02), patients aged 18 to 80 years who underwent repair of the gluteus medius, minimus, or both tendons with a single, fellowship-trained surgeon (S.J.N.) between January 20, 2012, and November 25, 2015, with a minimum 22-month clinical follow-up were retrospectively identified from a database of prospectively collected data. Exclusion criteria included patients who lived out of state and were not able to travel to our institution

Demographics

Forty-seven patients who underwent gluteus medius or minimus repair >22 months after surgery were identified from the senior surgeon's surgical repository and met exclusion criteria. Thirty-eight (80.9%) of those patients agreed to be radiographically evaluated with a scoliosis series, and those patients were included in the analysis. The characteristics of patients who were radiographically evaluated were similar to the patients in the whole sample (Tables 1 and 2). Thirty two patients (84.2%)

Discussion

The results of this study suggest that nearly half (47%) of patients with gluteus medius tear in this study have a radiographically defined adult scoliosis, and most patients (55%) had these tears on the concave side of the major curve. The concavity of the major curve was not associated with significantly different outcomes after a surgical repair of the gluteus medius/minimus. However, patients with scoliosis (Cobb angle >10°) had significantly lower postoperative iHOT-12 scores than their

Conclusions

Patients with scoliosis presented with lower symptoms improvements, and ability to return to an active lifestyle in patients with hip disorders. In addition, patients with positive sagittal plane deformity experienced lower hip-related sport-specific outcome scores. Although the direct relationship between the spine and the hip in patients after gluteus medius/minimus repair remain unclear, this study shows an association between these postoperative outcomes and spinopelvic parameters.

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Cited by (15)

Patients with operative gluteus medius tears often present with a concomitant history of lumbar pathology
2024, Journal of Orthopaedics
Studies have indicated a correlation between patients presenting with decreased gluteus medius function and a history of lumbar pathology (LP). However, literature investigating the relationship between the prevalence of lumbar pathology in patients with gluteus medius tears is lacking. The purpose of this study is to determine if patients undergoing repair for gluteus medius tears have concomitant lumbar pathology.
Patients aged 18–80 who underwent endoscopic gluteus medius repair by one fellowship-trained surgeon between May 2016 and May 2020 for peritrochanteric pain/tenderness, abductor weakness, and MRI findings consistent with a gluteus medius tear were identified. Pre-operative and post-operative data were gathered using the Visual Acuity Scale (VAS), and post-operative data was gathered using the Abbreviated International Hip Outcome Tool (iHOT-12) and Hip Outcome Score – Activities of Daily Living (HOS-ADL). Outcomes were compared between patients with and without a history of lumbar pathology.
Of 23 hips, 19 (82.6%) presented with a prior history of lumbar pathology. Twenty (87.0%) patients identified were female. A total of 19 hips were included with completed PROM scores. Patients with lumbar pathology had similar pre and post-operative patient reported outcomes.
This study demonstrates a high incidence of lumbar pathology in patients presenting for operative gluteus medius tears, which may suggest an association between lumbar disease and the development of gluteus medius weakness and tears.
The Gluteus Medius Experiences Significant Excursion With Hip Flexion
2023, Arthroscopy, Sports Medicine, and Rehabilitation
To evaluate the effect of hip flexion and rotation on excursion of the gluteus medius (Gmed) and minimus (Gmin) myotendinous unit.
Seven hips from 4 cadaveric specimens (males, 68.5 ± 18.3 years old) were dissected to isolate the Gmed posterior and lateral insertions and the Gmin proximal and distal insertions. Sutures were placed from tendon insertions through origins created in the iliac fossa to simulate the myotendinous unit. A load of 10N was applied. Myotendinous excursion was measured at 10° hip extension and 0°, 45°, and 90° of hip flexion in neutral rotation, and from maximum internal and external rotation in 90° flexion. The amount of abduction and rotation was also measured at each flexion position with 20N applied to each tendon. Repeated-measures analysis of variance with Tukey post hoc was used for statistics.
Gmed-lateral excursion ranged from 2.4 ± 0.4 mm in 10° of hip extension to 23.0 ± 1.5 mm in 90° of flexion (P < .001), and Gmed-posterior excursion ranged from 0.92 ± 0.5 mm in 10° of extension to 38.1 ± 1.1 mm in 90° of flexion (P < .001). Gmin excursion shortened with hip flexion from 4.2 ± 0.3 mm in 10° of extension to −0.2 ± 1.5 mm in 90° of flexion (Gmin-prox: P = .525, Gmin-distal: P < .001). At 90° flexion from maximum internal to maximum external rotation, Gmin-distal and proximal demonstrated a 92.6% and 51.3% increase in excursion, respectively (P < .001). Gmed-lateral and Gmed-posterior demonstrated 49.4% and 23.1% increase in excursion with external rotation, respectively (P < .001).
The Gmed myotendinous unit undergoes significant excursion with hip flexion, whereas both Gmed and Gmin had significant excursion with femoral external rotation in 90° flexion.
It is important to understand whether active or passive hip flexion or rotation in the early postoperative period causes excessive strain to an abductor tendon repair. We found that consideration should be given to limit flexion after Gmed repair and external rotation after Gmed or Gmin repairs.
Spinopelvic Parameters Do Not Influence Outcomes Following Primary Hip Arthroscopy for the Treatment of Femoroacetabular Impingement Syndrome
2023, Arthroscopy, Sports Medicine, and Rehabilitation
Citation Excerpt :
When we examined spinopelvic parameters (PT, SS, PI, LL, PI-LL, T9-spinopelvic inclination, sagittal vertical axis [SVA], T1-pelvic angle) in 107 patients with evidence of sagittal spinal deformity following THA using stereoradiographic EOS, DelSole et al.16 reported a high dislocation rate (8%), with patients suffering dislocation possessing significantly greater spinopelvic tilt and PI-LL mismatch. Meanwhile, when evaluating spinopelvic parameters on outcomes in 38 patients at a minimum of 22 months following gluteus medius/minimus repair, Saltzman et al.41 reported that patients with a positive sagittal vertical axis (SVA > 0 cm) reported significantly worse HOS-ADL (P = .026) and HOS-SS (P = .011) when compared with patients with a SVA <0 cm. As such, although the relationship between the spine and the hip in patients undergoing various hip procedures has been established, further investigations are warranted to better understand the influence of spinopelvic mechanics and anatomy using additional spinopelvic parameters and advanced imaging modalities (i.e., computed tomography [CT], magnetic resonance imaging [MRI]) on outcomes following hip arthroscopy for FAIS.
To evaluate the influence of spinopelvic parameters on short-term postoperative patient-reported outcomes (PROs) following primary hip arthroscopy for the treatment of femoroacetabular impingement syndrome (FAIS).
Patients undergoing primary hip arthroscopy between January 2012 and December 2015 were retrospectively reviewed. Hip Outcome Score – Activities of Daily Living, Hip Outcome Score – Sports-Specific Subscale, modified Harris Hip Score, International Hip Outcome Tool-12, and visual analog scale pain were recorded preoperatively and at final follow-up. Lumbar lordosis (LL), pelvic tilt (PT), sacral slope, and pelvic incidence (PI) were measured on lateral radiographs in standing position. Patients were split into subgroups for individual analyses based on previous literature cutoffs: |PI-LL|> or <10°, PT> or <20°, and PI <40°, 40° < PI < 65°, and PI >65°. PROs and rate of achievement of patient acceptable symptom state (PASS) were compared between subgroups at final follow-up.
Sixty-one patients who underwent unilateral hip arthroscopy were included in the analysis, and 66% of patients were female. Mean patient age was 37.6 ± 11.3 years, whereas mean body mass index was 25.0 ± 5.7. Mean follow-up time was 27.6 ± 9.0 months. No significant difference in preoperative nor postoperative PROs were appreciated in patients with spinopelvic mismatch (|PI-LL| >10°) versus those without, whereas patients with mismatch achieved PASS according to the modified Harris Hip Score (P = .037) and International Hip Outcome Tool-12 (P = .030) at greater rates. When we compared patients with a PT ≥20° versus PT <20°, no significant differences in postoperative PROs were present. When we compared patients in the following pelvic incidence groups: PI <40°, 40° < PI <65°, and PI >65°, no significant differences in 2-year PROs or rates of PASS achievement for any PRO were appreciated (P > .05 for all).
In this study, spinopelvic parameters and traditional measures of sagittal imbalance did not influence PROs in patients undergoing primary hip arthroscopy for FAIS. Patients with sagittal imbalance (|PI-LL|> 10° or PT >20°) achieved a greater rate of PASS.
IV; Prognostic case series.
Hip Abductor and Peritrochanteric Space Conditions
2021, Clinics in Sports Medicine
Citation Excerpt :
Physical examination findings including tenderness to palpation of the greater trochanter, decreased abduction strength, and abductor atrophy may be notable.30 Patients may also walk with an antalgic and/or Trendelenburg gait.21,31 The most commonly used imaging includes plain radiographs, ultrasonography, and MRI.2,32
Hip Gluteus Medius and Minimus Endoscopic Treatment Results in Patient Satisfaction
2020, Arthroscopy - Journal of Arthroscopic and Related Surgery
Greater trochanteric pain syndrome includes a spectrum of hip pathology, including trochanteric bursitis, gluteus medius or minimus tendinosis, partial abductor tear, full-thickness tear, and full-thickness tear plus retraction (with or without fatty atrophy). Physical diagnosis includes palpation for tenderness at the greater trochanter and evaluation for strength loss, including observation of gait. Women are significantly more likely to have a tear of the hip abductors than men. Endoscopic treatment results in patient satisfaction, improved strength and gait, and few complications. Fatty degeneration of the abductor muscles or associated scoliosis has a negative effect on the outcome of gluteus medius repair.
Editorial Commentary: On Mentors and “Peeling Onions”: Scoliosis Results in Inferior Outcomes Following Hip Gluteus Medius Tendon Repair
2019, Arthroscopy - Journal of Arthroscopic and Related Surgery

View all citing articles on Scopus

: See commentary on page 1099

: The authors report the following potential conflicts of interest or sources of funding: S.N. receives research support from Allosource Arthrex,Inc, Athletico, DJ Orthopaedics, Linvatec, Miomed, Smith and Nephew, and Stryker; is a member of the editorial/governing board of the American Journal of Orthopedics; is a board/committee member of the American Society for Sports Medicine and the Arthroscopy Association of North America; is a paid consultant for Ossur; receives IP royalties from Ossur; receives publishing royalties from Springer; and receives financial/material support from Springer. Full ICMJE author disclosure forms are available for this article online, as supplementary material.

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Original ArticleAssessment of Association Between Spino-Pelvic Parameters and Outcomes Following Gluteus Medius Repair

Purpose

Methods

Results

Conclusions

Level of Evidence

Section snippets

Patient Selection

Demographics

Discussion

Conclusions

Arthroscopy

Orthop Traumatol Surg Res

J Arthroplasty

Arthroscopy

J Arthroplasty

J Shoulder Elbow Surg

Arthroscopy

Arthrosc Tech

J Arthroplasty

J Arthroplasty

Arthroscopy

Arthroscopy

Tendinosis and tears of gluteus medius and minimus muscles as a cause of hip pain: MR imaging findings

AJR Am J Roentgenol

Abductor tendon tears of the hip: Evaluation and management

J Am Acad Orthop Surg

Clinical presentation and imaging results of patients with symptomatic gluteus medius tears

J Hip Preserv Surg

Rotator cuff tears of the hip

Clin Orthop Relat Res

Original Article
Assessment of Association Between Spino-Pelvic Parameters and Outcomes Following Gluteus Medius Repair