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Abstract

Background:

Chronic hip abductor insufficiency remains a challenging problem to treat and can result in significant disability in some patients. Tendon transfers involving the gluteus maximus (GM) or combined GM with tensor fascia latae (GM+TFL) are common options for surgical reconstruction. The purpose of this systematic review was to compare clinical outcomes, complications, and revisions rates of patients who underwent GM transfer or GM+TFL transfer for irreparable hip abductor tears.

Methods:

PubMed (MEDLINE), Scopus (EMBASE, MEDLINE, COMPENDEX), and Cochrane databases were used to conduct a systematic review of articles from inception to February 2025. A total of 18 studies were included (11 GM transfer, 7 GM+TFL transfer). Demographics, hip setting (native hip, primary total hip arthroplasty [THA], revision THA), patient-reported outcome measures, presence of Trendelenburg gait, abduction strength, complication rates, and revision rates were analysed.

Results:

A total of 207 patients (208 hips) underwent GM transfer, while 55 patients (55 hips) underwent GM+TFL transfer. Meta-analyses demonstrated that both techniques yielded significant preoperative to postoperative improvements in modified Harris Hip Scores/Harris Hip Scores and Visual Analogue Scale pain scores (p < 0.001). In total, 33.9% of patients who underwent GM transfer had a persistent Trendelenburg gait postoperatively, compared to 48.1% of those who underwent GM+TFL transfer. The complication rate was 16.8% (23/137) for patients who underwent GM transfer and 2.7% (1/37) for those who underwent GM+TFL transfer; while revision rates were 5.9% (9/152) and 3.6% (2/55), respectively.

Conclusions:

Both GM and GM+TFL transfers yielded comparable outcomes in patients with chronic hip abductor insufficiency not amendable to primary repair. The complication rate was substantially higher in patients who underwent GM transfer, whereas revision rates were comparably low for both techniques. In particular, a sizeable proportion of patients continued to exhibit a persistent Trendelenburg gait postoperatively following both surgical techniques, highlighting the complexity of this pathology.

PROSPERO registration number:

CRD420251002466

Keywords

Abductor gluteus maximus hip arthroplasty tensor fascia latae tendon transfer Trendelenburg

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References

Lindner

Shohat

Botser

, et al. Clinical presentation and imaging results of patients with symptomatic gluteus medius tears. J Hip Preserv Surg 2015; 2: 310–315.

Sharma

Velichala

Wyatt

, et al. Return to recreational activity after hip abductor repair: a systematic review. J Orthop 2025; 62: 216–223.

Domb

Owens

Maldonado

, et al. Favorable and durable outcomes at 10-year follow-up after endoscopic gluteus medius repair with concomitant hip arthroscopy. Arthroscopy 2024; 40: 2215–2224.

Byrd

JWT

Jones

Duncan

Endoscopic hip abductor tendon repair results in successful outcomes with 5- to 10-year follow-up. Arthroscopy 2024; 40: 1816–1821.

Whiteside

Roy

ME.

Incidence and treatment of abductor deficiency during total hip arthroplasty using the posterior approach: repair with direct suture technique and gluteus maximus flap transfer. Bone Joint J 2019; 101-B(Suppl. B): 116–122.

Caviglia

Cambiaggi

Vattani

, et al. Lesion of the hip abductor mechanism. Sicot J 2016; 2: 29.

Fehm

Huddleston

Burke

, et al. Repair of a deficient abductor mechanism with Achilles tendon allograft after total hip replacement. J Bone Joint Surg Am 2010; 92: 2305–2311.

Christofilopoulos

Kenanidis

Bartolone

, et al. Gluteus maximus tendon transfer for chronic abductor insufficiency: the Geneva technique. Hip Int 2021; 31: 751–758.

Portet

Lambrey

Benhenneda

, et al. Short-term functional outcomes of Whiteside transfer for massive rupture of gluteus medius tendon in native hips. Int Orthop 2024; 48: 57–64.

10.

Centre for Evidence-Based Medicine. Oxford Centre for Evidence-Based Medicine: Levels of Evidence (March 2009), https://www.cebm.ox.ac.uk/resources/levels-of-evidence/oxford-centre-for-evidence-based-medicine-levels-of-evidence-march-2009 (2009, accessed 3 May 2025).

11.

Slim

Nini

Forestier

, et al. Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg 2003; 73: 712–716.

12.

Balazs

Dooley

Wang

, et al. Gluteus maximus transfer for irreparable hip abductor tendon tears: technique and clinical outcomes. Tech Orthop 2021; 36: 87–91.

13.

Brenneis

Flevas

Gayle

, et al. Gluteus maximus transfer for wound closure and treatment of abductor deficiency: a single-plastic surgeon series. Arch Orthop Trauma Surg 2023; 143: 6927–6933.

14.

Jimenez-Telleria

Foruria

Moreta

, et al. Gluteus medius repair using a gluteus maximus flap augmented with synthetic polyethylene mesh: surgical technique and case series. Orthop Rev (Pavia) 2022; 14: 31904.

15.

Lemme

Dworkin

Morrissey

, et al. Short-term outcomes following open gluteus maximus transfer for the management of hip abductor tears. J Hip Preserv Surg 2023; 10: 143–148.

16.

Quisquater

Timmermans

Vandenabeele

, et al. Gluteus maximus transfer as an augmentation technique for patients with severe abductor deficiency of the hip. Orthopedics 2020; 43: e299–e305.

17.

Ruckenstuhl

Wassilew

Müller

, et al. Functional assessment and patient-related outcomes after gluteus maximus flap transfer in patients with severe hip abductor deficiency. J Clin Med 2020; 9: 1823.

18.

Ruckenstuhl

Wassilew

Theobald

, et al. Recovery of muscular tissue and functional results of patients treated with a gluteus maximus flap transfer due to chronic abductor deficiency after total hip arthroplasty. Arch Orthop Trauma Surg 2024; 144: 3063–3071.

19.

Whiteside

LA.

Surgical technique: transfer of the anterior portion of the gluteus maximus muscle for abductor deficiency of the hip. Clin Orthop Relat Res 2012; 470: 503–510.

20.

Zügner

Hjelmberg

Rolfson

, et al. Gluteus maximus transfer following total hip arthroplasty does not improve abductor moment: a case-control gait analysis study of 15 patients with gluteus medius disruption. J Clin Med 2022; 11: 3172.

21.

Annin

Lall

Meghpara

, et al. Intraoperative classification system yields favorable outcomes for patients treated surgically for greater trochanteric pain syndrome. Arthroscopy 2021; 37: 2123–2136.

22.

Bauwens

Haidar

Thaunat

Endoscopic transfer of gluteus maximus and tensor fasciae latae for massive gluteus medius tear: preliminary results. Orthop Traumatol Surg Res 2021; 107: 102927.

23.

Burns

Bornes

Al Khalifa

, et al. Surgical technique: abductor reconstruction with gluteus maximus and tensor fascia lata in revision total hip arthroplasty. J Arthroplasty 2022; 37: S628–S635.

24.

Chandrasekaran

Darwish

Vemula

, et al. Outcomes of gluteus maximus and tensor fascia lata transfer for primary deficiency of the abductors of the hip. Hip Int 2017; 27: 567–572.

25.

Maldonado

Annin

Chen

, et al. Combined transfer of the gluteus maximus and tensor fasciae latae for irreparable gluteus medius tear using contemporary techniques: short-term outcomes. JBJS Open Access 2020; 5: e20.00085.

26.

Whiteside

LA.

Surgical technique: gluteus maximus and tensor fascia lata transfer for primary deficiency of the abductors of the hip. Clin Orthop Relat Res 2014; 472: 645–653.

27.

Song

Inclan

Kuhn

, et al. Gluteus maximus transfer for irreparable hip abductor deficiency: a systematic review and meta-analysis. J Arthroplasty 2024; 39: 1117–1124.e1.

28.

Kohl

Evangelopoulos

Siebenrock

, et al. Hip abductor defect repair by means of a vastus lateralis muscle shift. J Arthroplasty 2012; 27: 625–629.

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Is combined gluteus maximus and tensor fascia latae transfer for irreparable hip abductor tears superior to gluteus maximus transfer alone? A systematic review and meta-analysis

Abstract

Background:

Methods:

Results:

Conclusions:

PROSPERO registration number:

Keywords

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References

Supplementary Material