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Gluteus maximus transfer for wound closure and treatment of abductor deficiency: a single-plastic surgeon series

  • Hip Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Due to the increasing number of total hip arthroplasties (THA), the number and complexity of revision procedures are also on the rise. For complex cases such as periprosthetic joint infections with soft tissue compromise or for abductor muscle deficiencies, one of the treatment options is a gluteus maximus flap (GMF) that covers dead space and can help restore the failed abductor mechanism. The purpose of this study is to investigate the outcomes of a single-plastic surgeon’s series of GMF procedures.

Materials and methods

This retrospective review reports on 57 patients (mean follow-up 39.2 months) undergoing GMF transfers for abductor insufficiency on native hip (N = 16), for abductor insufficiency in aseptic revision THA (rTHA) (N = 16), for soft tissue defects in aseptic rTHA (N = 8) and for soft tissue defects in septic rTHA (N = 17) by a single plastic surgeon over a 10-year period. Revision-free survival and complication rates were assessed and risk factors were analyzed with Cox-regression analysis.

Results

The reoperation-free survival rate of GMF for abductor insufficiency in native hips was 100%. GMF procedures for soft tissue defects in septic rTHA had the lowest cumulative revision-free survival (34.3%) and highest reinfection rates (53.9%). More than three prior surgeries (HR = 2.9, p = 0.020), presence of infection (HR = 3.2, p = 0.010) and resistant organisms (HR = 3.1, p = 0.022) significantly increased the risk of revision.

Conclusions

GMF is a viable option for addressing abductor insufficiency in native hip joints. However, high revision and complication rates are reported for GMF in septic rTHA. This study highlights the need to clarify the circumstances for which the flap reconstruction will be indicated.

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Data availability

The data that support the findings of this study are available on request from the corresponding author, [M.B.]. The data are not publicly available because they contain information that could compromise the privacy of research participants.

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Acknowledgements

The authors acknowledge Joseph T. Nguyen for helping with statistical analysis.

Funding

Research reported in this publication was supported by the Stavros Niarchos Complex Joint Reconstruction Center at Hospital for Special Surgery. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Center. Furthermore, the study was supported by the Stiftung Friedrichsheim, Frankfurt, Germany. Both had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Authors and Affiliations

  1. Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY, USA

    Marco Brenneis, Dimitrios A. Flevas & Peter K. Sculco

  2. Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY, USA

    Friedrich Boettner & Geoffrey H. Westrich

  3. Division of Plastic Surgery, New York-Presbyterian Hospital, New York, NY, USA

    Lloyd B. Gayle

  4. Department of Orthopedics (Friedrichsheim), University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany

    Marco Brenneis

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  1. Marco Brenneis
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  2. Dimitrios A. Flevas
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  3. Lloyd B. Gayle
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  4. Friedrich Boettner
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  5. Peter K. Sculco
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  6. Geoffrey H. Westrich
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Correspondence to Marco Brenneis.

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All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.

Ethic approval

This single-center retrospective study was approved by the Institutional Review Board (IRB number 2022–0964). This study was performed in line with the principles of the Declaration of Helsinki.

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Brenneis, M., Flevas, D.A., Gayle, L.B. et al. Gluteus maximus transfer for wound closure and treatment of abductor deficiency: a single-plastic surgeon series. Arch Orthop Trauma Surg 143, 6927–6933 (2023). https://doi.org/10.1007/s00402-023-04968-x

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  • DOI: https://doi.org/10.1007/s00402-023-04968-x

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