Outcomes of Direct Anterior Total Hip Arthroplasty in Patients Who Have Preoperative Gluteal Tendinopathy and Tears: A Propensity-Matched Analysis

Background: The gluteus medius and minimus muscles play a critical role in hip biomechanics, however there is a paucity of literature examining the impact of preoperative gluteal pathology on outcomes following total hip arthroplasty (THA). This study compared pain, satisfaction, and functional outcomes among patients who had and did not have preoperative gluteal pathology after direct anterior (DA) THA.

Methods: Using an institutional total joint registry, patients undergoing DA THA for osteoarthritis between 2010 and 2022 were retrospectively reviewed. Those who had magnetic resonance imaging (MRI) evidence of gluteal tear or tendinopathy within one year before surgery were propensity-matched on a 1:4 basis by age, sex, body mass index (BMI), laterality, year of surgery, and surgeon to patients who had no clinical evidence of abductor pathology. There were 22 patients who had gluteal tears (8 of 22 men, age 63 ± 8.1 years) and 29 who had gluteal tendinopathy (9 of 29 men, age 60 ± 10.4 years) who were respectively matched to 88 and 116 controls and followed for 4.0 ± 2.3 (range 1.1 to 12.7) years following DA THA. Postoperative outcomes were assessed using a Visual Analog Scale (VAS) at rest, VAS with use, Hip Disability and Osteoarthritis Outcome Score (HOOS) Pain, Forgotten Joint Score-12 (FJS-12), and modified Harris Hip Score (mHHS). Subsequent injections and reoperations were recorded.

Results: While all achieved excellent outcomes, patients who had gluteal tears experienced less improvement in pain and function compared to controls, trending towards a lower final mHHS score (P = 0.052). Patients who had gluteal tendinopathy reported worse pain, satisfaction, and function than controls according to measures of VAS at rest (P = 0.014), VAS with use (P = 0.003), HOOS pain (P = 0.005), FJS-12 (P = 0.003), and mHHS (P = 0.007). Postoperative injections and subsequent hip surgeries were infrequent despite no intraoperative tendon treatment. Key limitations included limited sample size and lack of intraoperative data.

Conclusion: Patients who had gluteal pathology do well following DA THA, however, gluteal tear and tendinopathy are associated with greater pain, decreased satisfaction, and inferior functional outcomes.