Related Experiment Video
Updated: May 21, 2026
The Transition to an Anterior-Based Muscle Sparing Approach Improves Early Postoperative Function but is Associated with a Learning Curve
Published on: September 7, 2022
Clinical, Radiological, and Kinematic Impact of Gluteus Maximus Tendon Release During Total Hip Arthroplasty: A
Ömer Faruk Naldöven1, Şahin Çepni2, Enejd Veizi3
1Department of Orthopedics and Traumatology, Kayseri City Hospital, Ankara Bilkent City Hospital.
Background:
Release of the gluteus maximus tendon during a total hip arthroplasty (THA) can lead to gluteal dysfunction. Sciatic nerve injury, while rare, remains a serious complication of THA. During deep hip flexion, release of the tendon increases the distance between the femoral neck and the sciatic nerve, potentially reducing the risk of nerve injury. The functional consequences of such a release have yet to be investigated. The aim of this study was to evaluate the effects of gluteus maximus tendon release on the development of gluteal dysfunction using clinical, radiological, and kinematic measurements.
Methods:
Between September 2023 and August 2024, 144 patients undergoing THA were prospectively randomized into three groups: (1) gluteal tendon preserved, (2) gluteal tendon released, and (3) gluteal tendon released and repaired. All patients received a standardized surgical and rehabilitation protocol. Clinical outcomes were assessed using a Visual Analog Scale, Harris Hip Score, and the Western Ontario and McMaster Universities Osteoarthritis Index scores, radiological evaluation included cross-sectional area and density of the gluteus maximus muscle on computed tomography, and kinematic analysis measured isokinetic hip extensor strength.
Results:
Postoperative clinical scores significantly improved in all groups. There were no differences among groups in muscle cross-sectional area or extensor strength at the final analysis. However, a significant decrease in muscle density was observed only in the gluteal tendon release group (11.5 ± 15.0 preoperatively versus 9.0 ± 16.6 Hounsfield unit postoperatively, P = 0.022). The incidence of sciatic nerve complications was low and similar among groups.
Conclusions:
Gluteus maximus tendon release does not negatively affect postoperative muscle strength or clinical outcomes but may lead to reduced muscle density. Tendon release may be considered in hips with limited exposure or high risk of sciatic nerve injury. Preservation or repair of the tendon is recommended when feasible.