Rupture of the gluteus medius tendon

Aim: Rupture of the gluteus medius tendon is a rare, even neglected condition. Typical findings include local tenderness and weakness of hip abduction. This pathologic condition is very seldom analysed in the literature, there is no report about the meaning in primary total hip replacement (THR). Patients: Between 1.1.1995 and 31.12.2000 we found B cases (3,5%) with a tear of the gluteus medius tendon in 372 primary THR using the lateral approach. In all cases the rupture was seen in the ventral and lateral part of the gluteus medius tendon. Furthermore, a valgus position of the proximal femur was detected. Transosseous refixation of the tendons was performed in all cases. 3 months after operation local tenderness near the greater trochanter disappeared and full strength of the pelvitrochanteric muscles was achieved in 11 out of 13 cases and in the remaining cases after one year. Conclusion: When a valgus position of the proximal femur in primary THR is found, one has to be aware of a simultaneous rupture of the gluteus medius tendon. This pathologic finding has to be ruled out preoperatively by means of ultrasound or MRI and an adequate approach to the hip joint has to be selected to examine the pelvitrochanteric muscles and to treat the rupture.