Möglichkeiten der Speedbridge-Technik

[Gluteal insufficiency]

Gluteal insufficiency or hip abductor mechanism deficiency mainly following (revision) total hip replacement is associated with highly painful complaints and severe suffering of patients. It represents a great diagnostic and therapeutic challenge. Differentiated conservative treatment pathways, open surgical and endoscopic anatomic repair techniques with intact gluteal musculature and muscle transfer are available as salvage procedures for chronic not anatomically reconstructable mass ruptures. A stepwise diagnostic and therapeutic approach is required for restoration of the quality of life and painless or almost painless mobility of affected patients in occupation and daily life.

[Surgical refixation of gluteal tendon tears by mini-open double-row technique]

OBJECTIVE

Stable refixation of gluteal tendons at the anatomic footprint by large-area contact by the means of knotless double-row anchor fixation (HipBridge technique).

INDICATIONS

Symptomatic tear of gluteus medius and/or gluteus minimus tendon with persisting pain after nonsurgical treatment, or primarily reconstructable mass rupture with gluteal insufficiency, revision surgeries.

CONTRAINDICATIONS

Primary nonreconstructable mass ruptures, atrophic or fatty degeneration of gluteal muscles grade Goutallier 4, local infections.

SURGICAL TECHNIQUE

Lateral position, longitudinal skin incision over greater trochanter, longitudinal incision of iliotibial band, resection of trochanteric subgluteus maximus bursa, longitudinal splitting of gluteal tendons over tear, debridement and mobilisation of tendons for sufficient distalisation to tendon footprint at anterior and lateral trochanteric facet, debridement of sclerotic greater trochanter, punching and tapping of proximal row, placement of two proximal anchors loaded with nonresorbable suture tape, fan-shaped four times gluteal tendon perforation at myotendinous transition zone, double-V-shape crossing of suture tapes, punching and tapping of distal row, fixation of crossed tapes with two distal knotless suture anchors under mild pretensioning of gluteal tendons, side-to-side tendon suture, vastogluteal and iliotibial band closure, wound closure.

POSTOPERATIVE MANAGEMENT

Stage-dependent physiotherapy with partial weight-bearing with 20 kg for 6 weeks, no active abduction, no adduction and no external rotation in flexion for 6 weeks after surgery. From week 7 after surgery, free range of motion, active-assisted abduction and increase in weight-bearing by 15 kg/week. No peak load for 4 months. Thromboembolic prophylaxis until full weight-bearing is reached.

RESULTS

Success rates of 80-90% can be expected in cases with no or only minor muscle atrophy.