Dermal Allograft Augmentation for Open Gluteus Medius Repair: A Case Series at 2-Year Follow-up

Abstract

Background:

Gluteus medius (GM) tears are a common cause of peritrochanteric regional pain and disability among middle-aged and older populations. While largely successful, when primary repair fails, it is often attributed to poor tendon quality. Dermal allograft augmentation offers a solution for this patient population by enhancing the biological and mechanical properties of the repair construct.

Purpose:

To evaluate the outcomes of open isolated GM repair with dermal allograft augmentation at 2-year follow-up, with a sex-based subanalysis comparing clinical outcomes in male versus female patients.

Study Design:

Case series; Level of evidence, 4.

Methods:

Prospectively collected data were retrospectively analyzed for all patients who underwent open GM repair with dermal allograft augmentation between June 2016 and April 2022. Included patients had complete preoperative and 2-year follow-up data for the following patient-reported outcome measures (PROMs): modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), International Hip Outcome Tool–12 (iHOT-12), visual analog scale for pain, and patient satisfaction; if complete 2-year follow-up data were not available, patients had a documented endpoint such as further surgery. Clinically relevant thresholds, complications, and secondary surgery were reported.

Results:

A total of 23 hips (18 female, 5 male) were included in this study. There were 17 primary procedures with dermal allograft augmentation (73.9%) and 6 revisions after prior GM repair without previous dermal allograft augmentation (26.1%). A significant improvement was observed on all evaluated PROMs, with 1 reoperation (4.4%) for a recurrent tear. A high percentage of patients achieved the minimal clinically important difference for the mHHS (86.4%), NAHS (81.8%), and iHOT-12 (72.7%). Moreover, 16 (72.7%) answered the patient acceptable symptom state anchor question positively. A sex-based subanalysis showed that female patients demonstrated a greater postoperative improvement on PROMs and a higher rate of achieving clinically relevant thresholds compared with male patients.

Conclusion:

Patients with extensive degenerative GM tears who underwent repair with dermal allograft augmentation had favorable outcomes with significant improvements on PROMs and low reoperation rates at short-term follow-up.