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Short-term functional outcomes of Whiteside transfer for massive rupture of gluteus medius tendon in native hips

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Abstract

Purpose

To assess the functional and clinical outcomes of patients who underwent either open or endoscopic Whiteside transfer of gluteus maximus and tensor fascia lata muscles in cases of massive rupture of gluteus medius tendon associated with muscle atrophy on a native hip

Methods

This retrospective, descriptive, single-centre study was conducted by a single operator with a minimum follow-up period of 12 months. All Whiteside palliative transfers performed on patients with Type 5 gluteus medius tendon rupture, according to Lall’s classification, resulting in painful and treatment-resistant Trendeleburg gait between 2017 and 2022 were included. Functional evaluation was based on modified Harris Hip Scores (mHHS), iHOT-12, Non-Arthritic Hip Score (NAHS), and the pain on a Visual Analog Scale (VAS). Muscle strength was clinically assessed using the MRC classification.

Results

Between January 2017 and January 2022, a total of 15 Whiteside palliative transfers were identified, including nine (60%) open procedures and 6 (40%) endoscopic procedures, performed on 13 patients. One patient was excluded, and none were lost to follow-up. The median follow-up period was 41 (12; 59) months. The median age at the time of surgery was 74 (66; 76) years. The male-to-female sex ratio was 0.27. Functional results demonstrated a significant improvement in all scores: NAHS (45 vs. 72, p = 0.002), mHHS (22 vs. 55, p = 0.002), iHOT-12 (101 vs. 56, p = 0.002), and VAS (8 vs. 3, p = 0.002). Clinical outcomes also showed improvements in muscle strength (p = 0.003), single-leg stance (p = 0.01), and gait (p = 0.02). No significant differences were found in the various scores between the endoscopic and open techniques.

Conclusion

Whiteside transfer surgery, whether performed through open surgery or endoscopically, is a palliative surgical approach that should be considered for patients with irreparable gluteus medius tendon tears, where the main symptom is trochanteric pain. This procedure yields satisfactory clinical and functional outcomes, although the gains in abduction strength recovery and gait improvement are modest.

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Authors and Affiliations

  1. Centre Orthopédique Santy, FIFA Medical Center of Excellence, Ramsay Santé, Hôpital Privé Jean Mermoz, 24, Avenue Paul Santy, 69008, Lyon, France

    Adrien Portet, Pierre-Jean Lambrey, Rayane Benhenneda, Luca Tanel & Mathieu Thaunat

  2. Service de chirurgie orthopédique et traumatologique, CHU de Lille, Lille, France

    Pierre-Jean Lambrey

  3. Department of Pediatric Orthopaedic Surgery, Lyon University Hospital for Mother and Children, Bron, France

    Paul-Henri Bauwens

Authors
  1. Adrien Portet
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  4. Luca Tanel
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  5. Paul-Henri Bauwens
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Contributions

1. Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND

2. Drafting the work or revising it critically for important intellectual content; AND

3. Final approval of the version to be published; AND

4. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Adrien Portet: 1, 2, 3, 4

Pierre-Jean Lambrey: 1, 2, 3, 4

Rayanne Bennehedda: 1, 2, 3, 4

Luca Tanel: 1, 2, 3, 4

Paul-Henri Bauwens: 1, 2, 3, 4

Mathieu Thaunat: 1, 2, 3, 4

Corresponding author

Correspondence to Mathieu Thaunat.

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Référence Direction Recherche et Enseignement Ramsay Santé:COS-RGDS-2023-04-004-THAUNAT-M - RB00010835

Conflict of interest

Dr Mathieu Thaunat has a potential conflict of interest. Dr Thaunat is a consultant for Arthrex. The other authors declare they have no financial interests.

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All patients gave valid consent to participate

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Level of Evidence: IV, case series with subgroup analysis

Investigation performed at Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Groupe Ramsay-Générale de Santé, Hopital Privé Jean Mermoz, Lyon, France

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Portet, A., Lambrey, PJ., Benhenneda, R. et al. Short-term functional outcomes of Whiteside transfer for massive rupture of gluteus medius tendon in native hips. International Orthopaedics (SICOT) 48, 57–64 (2024). https://doi.org/10.1007/s00264-023-06050-y

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