Integrity of the gluteus medius after the transgluteal approach in total hip arthroplasty

The postoperative integrity of the conjoined aponeurosis of the gluteus medius and vastus lateralis was studied in 97 consecutive total hip arthroplasties in 95 patients performed via a transgluteal approach. Metal markers were placed in the gluteal/vastus aponeurosis, one on each side of the suture line, and the integrity of the repair was assessed on radiographs taken immediately after surgery and 2 weeks, 2 months, and 1 year after operation. Separation between the markers occurred in about half of the patients, but gross separations were rare. Since most separations showed a progressive increment, elongation of the sutured aponeurosis might be a more common mechanism than perioperative injury to the neurovascular pedicle. Moreover, the degree of separation did not correlate with pain, and Trendelenburg gait was significantly increased only in the group of patients with a separation greater than 2.5 cm, indicating that a moderate gluteal elongation may be readily compensated for.