Surgical Technique: Transfer of the Anterior Portion of the Gluteus Maximus Muscle for Abductor Deficiency of the Hip

BACKGROUND: Loss of the abductor portions of the gluteus medius and gluteus minimus muscles due to THA causes severe limp and often instability. DESCRIPTION OF TECHNIQUE: To minimize the symptoms of limp and instability, the anterior ½ of the gluteus maximus was transferred to the greater trochanter and sutured under the vastus lateralis. A separate posterior flap was transferred under the primary flap to substitute for the gluteus minimus and capsule. To ensure tight repair, the flaps were attached and tensioned in abduction. PATIENTS AND METHODS: The technique was performed in 11 patients (11 hips) with complete loss of abductor attachment; the procedure was performed in nine patients during THA and in two later as a secondary procedure. Preoperatively, all patients had abductor lurch, positive Trendelenburg sign, and no abduction of the hip against gravity. Minimum followup was 16 months (mean, 33 months; range, 16-42 months). RESULTS: Postoperatively, nine patients had strong abduction of the hip against gravity, no abductor lurch, and negative Trendelenburg sign. One patient had weak abduction against gravity, negative Trendelenburg sign, and slight abductor lurch. One patient failed to achieve strong abduction, had severe limp after 6 months of protection and physical therapy, and was lost to followup. CONCLUSIONS: Gluteus maximus transfer can restore abductor function in THA with a high success rate.