title: Surgical technique: Gluteus maximus and tensor fascia lata transfer for primary deficiency of the abductors of the hip.
abstract: BACKGROUND
  Avulsion of the abductor muscles of the hip may cause severe limp and pain. Limited literature is available on treatment approaches for this problem, and each has shortcomings. This study describes a muscle transfer technique to treat complete irreparable avulsion of the hip abductor muscles and tendons.
  
  
  METHODS
  Ten adult cadaver specimens were dissected to determine nerve and blood supply point of entry in the gluteus maximus and tensor fascia lata (TFL) and evaluate the feasibility and safety of transferring these muscles to substitute for the gluteus medius and minimus. In this technique, the anterior portion of the gluteus maximus and the entire TFL are mobilized and transferred to the greater trochanter such that the muscle fiber direction of the transferred muscles closely matches that of the gluteus medius and minimus.
  
  
  METHODS
  Five patients (five hips) were treated for primary irreparable disruption of the hip abductor muscles using this technique between January 2008 and April 2011. All patients had severe or moderate pain, severe abductor limp, and positive Trendelenburg sign. Patients were evaluated for pain and function at a mean of 28 months (range, 18-60 months) after surgery.
  
  
  RESULTS
  All patients could actively abduct 3 months postoperatively. At 1 year postoperatively, three patients had no hip pain, two had mild pain that did not limit their activity, three had no limp, and one had mild limp. One patient fell, fractured his greater trochanter, and has persistent limp and abduction weakness.
  
  
  CONCLUSIONS
  The anterior portion of the gluteus maximus and the TFL can be transferred to the greater trochanter to substitute for abductor deficiency. In this small series, the surgical procedure was reproducible and effective; further studies with more patients and longer followup are needed to confirm this.
authors: Missouri Bone and Joint Center, Missouri Bone and Joint Research Foundation, 1000 Des Peres Road, Suite 150, St Louis, MO, 63131, USA, whiteside@whitesidebio.com.
authors: Leo A
authors: LA
authors: Whiteside
mesh_terms: D000368:Aged; D018771:Arthralgia / Q000209:etiology / Q000601:surgery; D001696:Biomechanical Phenomena; D002102:Cadaver; D005206:Fascia Lata / Q000098:blood supply / Q000294:innervation / Q000503:physiopathology / Q000601:surgery; D005240:Feasibility Studies; D005260:Female; D005269:Femur / Q000601:surgery; D005684:Gait; D006621:Hip Joint / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007593:Joint Instability / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000098:blood supply / Q000294:innervation / Q000503:physiopathology / Q000601:surgery; D019637:Orthopedic Procedures / Q000379:methods*; D010149:Postoperative Pain / Q000209:etiology; D020127:Recovery of Function; D013524:Surgical Flaps; D013997:Time Factors; D016896:Treatment Outcome
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