Achilles Tendon for the Treatment of Gluteus Medius Insufficiency (HLS)

Residual limping after total hip arthroplasty is a serious complication that lacks effective treatment. The purpose of this study is to evaluate a surgical treatment for residual limping and compare its results with non-surgical treatment. Our hypothesis is that surgical treatment followed by physiotherapy increases hip function and reduces limping compared with non-surgical treatment with physiotherapy alone.

Residual limping due to gluteus medius insufficiency after total hip arthroplasty is a serious complication that lacks effective treatment. The purpose of this study is to evaluate surgical reconstruction of gluteus medius using Achilles tendon allograft and compare its results and adverse events with non-surgical treatment. Our hypothesis is that surgical reconstruction followed by physiotherapy increases hip function and reduces limping compared with non-surgical treatment with physiotherapy alone.

Randomized controlled trial with the option of crossover in the control group after a certain period of time.

22 patients undergo surgical reconstruction of gluteus medius with allograft consisting of Achilles tendon with calcaneus block. The calcaneus block is fixed into the greater trochanter and the Achilles tendon i passed through the gluteus medius muscle, tensioned and sutured into the muscle. Postoperatively, partial weight bearing for 2 months followed by physiotherapy for 10 months.

22 patients receive non-operative treatment for their limp with physiotherapy alone during a 12-month period.

Patient-reported health-related quality of life measured with swedish version of the euroqol 5 dimension 5 level index in a scale 0-1

Inclusion Criteria: Persisting limping with positive Trendelenburg's sign for at least 12 months after total hip arthroplasty Rupture/avulsion of the gluteus medius tendon verified with ultrasound or MRI Leg length discrepancy of less than 1 cm Femoral offset discrepancy of less than 25% Exclusion Criteria: Neuromuscular disorders

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