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Arthroscopic revision release of gluteal muscle contracture after failed primary open surgery
Xintao Zhang1,2, Xiaocheng Jiang2, Feilin He2
1Academy of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, 510630, China.
Purpose:
The treatment of gluteal muscle contracture (GMC) after failed primary open release surgery has rarely been reported in the literature. GMC is a troublesome health problem in some developing countries, and it can result in the limitation of patients' hip function, leading to the development of inferiority complexes. The aim of this study is to evaluate the effect of arthroscopic revision surgery after failed primary open release on patients with GMC.
Methods:
A total of 278 hips of 140 patients who underwent arthroscopic revision procedures after failed primary open surgeries were gathered from the department files. All patients were treated using a "three-step" arthroscopic release procedure by the same surgeon group.
Results:
The mean follow-up for the 136 patients was 38.9 months. There was significant difference (P < 0.05) between the patients' mean post-revision and pre-operative results on the Harris scoring system. Unreleased contracture tissues that needed revision operations included the gluteus maximus, tensor fasciae latae muscle, and gluteus medius in all patients, and the gluteus minimus and hip capsule in 11.0% and 8.1% of patients, respectively. Short-term complications included subcutaneous bruising of the abdomen in 11 patients, extensive ecchymosis in the lateral thigh in 12 patients, and a transient reduction of muscle strength in all patients. No complications involving postoperative incision infection, nerve and blood vessel damage, or positive Trendelenburg sign occurred. Symptoms of hip snapping and limitation of range of motion (ROM), combined with a positive Trendelenburg sign in two patients after the primary open surgery, were all resolved except for the Trendelenburg sign through arthroscopic revision release. The overall satisfaction rate of the revision operations was 90.4%.
Conclusion:
The three-step arthroscopic release procedure is effective for failed primary open GMC surgeries as shown by improved post-operative function and patient satisfaction regardless of which primary procedure was performed.
