Two novel surgical procedures pioneered by orthopedic surgeons at Houston Methodist are showing promising results in the treatment of hip abductor tears, a common but historically undertreated injury that can result in progressive lateral hip pain, weakness, limping and debility.

In a recent Journal of Arthroplasty study, Houston Methodist researchers reported that the new techniques resulted in significant improvements in pain, gait and muscle strength for both simple and complex tears. The study analyzed clinical and MRI findings from the hospital's first 45 procedures using the techniques.

"For too many years, hip abductor tears have lacked a clear consensus on management, resulting in suboptimal outcomes for a large number of patients, typically seniors, who don't respond to standard nonoperative care," says Dr. Stephen Incavo, chief of Orthopedics and Sports Medicine at Houston Methodist and the study's primary investigator. "With these new options, we can address the full continuum of injury and help patients regain critical functionality at a time when they need it the most."

Five years ago, Dr. Incavo introduced a new repair technique for moderate to severe type II tears of the gluteus medius using a greater trochanter longitudinal bone trough approach.

For less serious type I tears of the gluteus minimus, Dr. Incavo and team developed a tendon tenodesis procedure to anchor the gluteus minimus to the gluteus medius.

Optimizing hip abductor repairs

Both procedures were specifically designed to address anatomical challenges that previous surgical approaches struggled to overcome.

The gluteus minimus is difficult to access without going through the gluteus medius. Until recently, patients were advised not to undergo surgery for type I tears, despite the unlikeliness such injuries will resolve on their own.

"We found you can reach around the medius and tie the minimus to the medius, stabilizing the smaller muscle without incurring unnecessary damage to the larger one," says Dr. Incavo.

For type II repairs, where the muscle has completely torn off the bone, the traditional repair technique is decortication and suture fixation.

"Although this operation can improve a patient's pain and functional capacity, the rates of retear are disappointingly high," Dr. Incavo says. "There's a lot of force on the muscle, so even after you tack it down to the bone, it still wants to pull off. The bone trough technique we developed is a more secure way to attach, offering a more durable solution."

Every little bit helps

Results highlighted in the Journal of Arthroplasty study include an overall improvement in pain score from 7.9 preoperatively to 2.1 postoperatively (P < .001); in assessment of muscle strength from 3.9 preoperatively to 4.6 postoperatively (P < .001); and in normal gait in 9% of patients preoperatively to 67% postoperatively (P < .001).

The study also found the procedures significantly improved return to activities, with 59% of patients responding they were satisfied with their ability to participate in activities they had enjoyed prior to the onset of hip injury.

Depending on the severity and chronicity of the tear, complete healing and restoration of functionality may not occur.

But the study suggests patients benefitted from the surgical intervention even in the setting of incomplete healing of tear. Postoperative MRI at six months showed healed tenodesis in 81% of type I tears and 50% of type II tears, with 85% of patients reporting that they would have the surgery again.

"Patients whose muscles have been damaged for a long time may still have a limp after surgery and may not gain 100% muscle strength back," Dr. Incavo says. "But across the board, patients are reporting less pain, improved mobility and better quality of life, so we are really happy with these results."

Dr. Incavo and team will continue to follow patients over time to document how well the improvements are maintained long-term. Meanwhile, he hopes word of these new procedures will continue to spread so more surgeons will begin performing them and more people with debilitating hip problems will be able to return to active, healthy lives.