Hip abductor repair surgery is a procedure designed to treat painful tendinosis and hip abductor tendon tears. Your hip ‘abducts ‘when you move your leg away from the midline of your body and this movement uses a combined contraction of your buttocks muscles and adds to your ability to walk, stand, and rotate your leg. During a traumatic event, such as direct impact when playing contact sport, or a hard fall, the tendinous attachment of these muscles can peel-off at their attachment site on the greater trochanter, an area near the top portion of your femur (thigh bone). Most commonly, the gluteus medius and gluteus minimus tendons sustain the injury and the tearing requiring surgery.
In general, the outcomes of hip abductor tendon repair are best for acute tears or partial thickness tears with good tissue quality. Outcomes also depend on several other factors, including your age, the extent of tearing or tendinosis and the extent of scarring or retraction. These factors will all be discussed with Dr Singh during your consultation, and he will guide you through the various considerations in helping you decide whether surgery is right for you.
The surgical procedure
Hip abductor repair surgery is an outpatient procedure, performed under general anaesthesia.
To begin the surgical procedure, Dr Singh makes an incision over the lateral aspect of your hip, down to the iliotibial (IT) fascia. The IT fascia is opened longways, and the trochanteric bursa is removed or debrided. The gluteal tendons are then identified and cleaned, and anchors are placed into the greater trochanter. Stitches are used to secure the gluteal tendons back to the bone and the IT fascia is partially closed with the extent of closure dependent on presentation.
The wound is then closed through the deep soft tissues and the skin.
Typically, a hip abductor repair procedure takes 1 – 2 hours from start to finish.
Recovery timelines
It is important to realise that the speed in your recovery depends largely on the extent and type of tearing/tendinosis along with other related factors. Partial thickness tears that have not completely separated from the bone or complete tears that are identified early (acute) tend to recover fastest. Chronic tears (present for > 6 months) that have completely separated from the bone (retracted) tend to form scar tissue and adhesions, which can complicate surgical repair and prolong recovery.
For most patients, timelines following hip abductor repair surgery are as follows:
- Day 1: Go home on the same day as surgery
- Day 1-2: Resume normal, daily household activities
- Day 3-5: Stop taking prescription pain medications
- Day 7-10: return to a desk-job with intermittent walking
- 2 Weeks: Drive a car (chronic/retracted tears may take longer)
- By 4 – 6 weeks: Walking unassisted and without a limp (acute/partial thickness) or 3 months (chronic/retracted)
- By 8 – 10 weeks: You can start running again (acute/partial thickness) or 3 – 4 months (chronic/retracted)
- 2 – 3 months (acute/partial thickness) return to unrestricted sports participation or a labour-intensive occupation or 4 – 6 months (chronic/retracted)
Post-surgical physiotherapy & rehabilitation
Physiotherapy is required following hip abductor repair surgery to ensure that you get the best possible outcome. With the guidance of your physio, you will progressively advance through various stages of your rehabilitation, as outlined in our post-operative protocol and your physiotherapist will have some flexibility to safely modify your progression to meet your specific goals and expectations.
REHABILITATION GUIDELINES
Each patient will progress at a different rate depending on the specific procedure performed, age, pre-injury health status and rehab compliance. All exercises should be performed within pain tolerance. Pushing to extremes of motion beyond pain tolerance does not enhance function but rather increases discomfort and may affect the healing tendon.
PHASE I (Surgery to 3 weeks)
APPOINTMENTS
You will have one appointment 2-5 days after surgery to make sure you are ambulating correctly and following precautions. Your second appointment will be 2-3 weeks after surgery (after the first post-op visit with Dr Singh) to begin the more formal exercise program.
REHABILITATION GOALS
Protection of the post-surgical hip through limited weight bearing and education on avoiding pain (approximately 3/10) with range of motion (ROM) exercises.
PRECAUTIONS
- No active abduction
- No passive adduction
- Normalise gait pattern with brace and crutches
- Weight-bearing: 10kgs for 6 weeks
RANGE OF MOTION EXERCISES
- Continuous passive motion (CPM) for 2 hours a day
- Bike for 20 minutes a day (can be 2 times a day) as tolerated
- Scar massage
- Hip passive range of motion (PROM)
- Hip flexion as tolerated; abduction as tolerated
- Log roll
- No active abduction and internal rotation (IR)
- No passive external rotation (ER) (4 weeks) or adduction (6 weeks)
- Stool stretch for hip flexors and adductors
- Quadruped rocking for hip flexion
- Gait training partial weight bearing (PWB) with assistive device
SUGGESTED THERAPEUTIC EXERCISES
- Hip isometrics for extension, adduction, ER at 2 weeks.
- Hamstring isotonic’s
- Pelvic tilts
- NMES to quads with SAQ with pelvic tilt
CARDIOVASCULAR
- Upper body circuit training or upper body ergometry (UBE)
PROGRESSION CRITERIA
- Normal gait with assistive device on level indoor surfaces with PWB and minimal to no pain
- Functional ROM without pain
- At least 3 weeks post-op
PHASE II (4-10 weeks post-surgery)
APPOINTMENTS
- Rehabilitation based on your progress, 1-2 times every 1-2 weeks
REHABILITATION GOALS
- Regain and improve muscular strength.
- Progress off crutches for all surfaces and distances
- Single leg stand control
- Good control and no pain with functional movements, including step up/down, squat, partial lunge
PRECAUTIONS
- Weeks 4-6: Gait training PWB with assistive device and no Trendelenburg gait – 10kg through 6 weeks
- Weeks 7-8: Gait training: increase weight bearing to 100% with crutches
- Weeks 9-10: Wean off crutches (2 to 1 to 0) without Trendelenburg gait / normal gait
SUGGESTED THERAPEUTIC EXERCISES
- Start isometric sub max pain free hip flexion (4 weeks)
- Stool rotations IR/ER (20°)
- Supine bridges
- Isotonic adduction
- Progress core strengthening (avoid hip flexor tendonitis)
- Progress with hip strengthening
- Quadriceps strengthening
- Scar massage
- Gait drills in the pool at chest deep water, as needed and available
At 8 weeks:
- Progress with ROM
- Hip joint mobs with mobilisation belt (if needed)
- Lateral and inferior with rotation
- Prone posterior-anterior glides with rotation
- rogress core strengthening (focus on post pelvic tilt and avoid hip flexor tendonitis)
CARDIOVASCULAR EXERCISE
- Upper body circuit training or UBE
PROGRESSION CRITERIA
- Normal gait on all surfaces
- Ability to carry out functional movements without unloading affected leg or pain, while demonstrating good control
- Single leg balance greater than 15 seconds without Trendelenburg
PHASE III (begin after meeting Phase II criteria, about 12 weeks)
APPOINTMENTS
- Rehabilitation based on your progress, 1-2 times every 1-2 weeks
REHABILITATION GOALS
- Regain and improve muscular strength
- Discontinue off crutches for all surfaces and distances
- Single leg stand control
- Good control and no pain with functional movements, including step up/down, squat, partial lunge
PRECAUTIONS
- Post-activity soreness should resolve within 24 hours
- No ballistic or forced stretching
- Avoid post-activity swelling or muscle weakness
- Be cautious with repetitive hip flexion activities, such as treadmill and Stairmaster
SUGGESTED THERAPEUTIC EXERCISES
- Stationary bike
- Gait and functional movement drills in the pool
- Standing hip abduction and extension, single leg bridging, side lying leg raises with leg in internal rotation and prone heel squeezes with hip extension
- Closed chain abductor strengthening – lateral stepping progressing to with bands, standing hip hikes, step backs
- Non-impact hip and core strengthening – body boards, bridging (progressing from double to single leg), mini band drills, physio ball drills
- Non-impact balance (progressing to single leg) and proprioceptive drills
- Half kneeling progression: stability, to reaching, to rotation, to resisted rotation
- Unilateral leg press
- Hip active ROM using D1 and D2 patterns with proprioceptive neuromuscular facilitation
- Stretching for patient specific muscle imbalances
CARDIOVASCULAR EXERCISE
- Non-impact endurance training; stationary bike, Nordic track, swimming, deep water run, cross trainer.
PROGRESSION CRITERIA
- Normal gait on all surfaces
- Ability to carry out functional movements without unloading affected leg or pain, while demonstrating good control
- Single leg balance greater than 15 seconds
You may return to sport after receiving clearance from Dr Singh and your physiotherapist.
Progressive testing will be completed.
You should have less than 15% difference in all strength tests, force plate run, jump and hop tests, and functional hop tests.
Potential surgical risks
Hip abductor repair surgery is generally a very successful procedure however, as with all surgical procedures there are certain risks and potential complications.
Blood clots: Clots (deep venous thrombosis or DVT) can occur in the veins of the legs after any surgery
Infection: This is a very serious complication which occurs in approximately 1% of cases.
Although uncommon, the Midwest Orthopaedics team take the following precautions to further minimise this risk:
- prior to surgery, your skin is tested to ensure resistant organisms are not present
- special skin wipes are used immediately prior to surgery.
- your limb is prepared with antiseptic on the ward prior to surgery
- intravenous antibiotics are used at the time of surgery
- the surgical team are required to wear special, self-enclosed theatre gowns
- any infection that develops after surgery is treated immediately
Failure of the Repair: (although very rare, 1-2%) due to poor tendon/muscle tissue
Fracture: Rare, however it is possible for the trochanter to crack during surgery.
Discovering any potential problems before surgery drastically reduces the risk of any of these complications from occurring.
Estimate of fees | hip abductor tendon repair surgery
As a privately insured patient at Midwest Orthopaedics, typically, costs associated with hip abductor repair surgery are as follows:
Your initial consultation fee, review consultation fee & Dr Singh’s surgical fees.
Your level of healthcare and your provider greatly influence your out-of-pocket expenses, so we recommend that you check with your health fund prior to booking in for surgery.
Other related charges include the Anaesthetist, the hospital fees and any in-patient pathology and radiology charges if x-rays or scans were required.
