The gluteal tendon can be damaged due to sudden traumatic injuries and also as a consequence of long-term wear and tear. Usually, damage occurs at the tendon attachment to the thighbone. Such a condition can initiate pain at the side of your hip. In a few cases, the tendon ruptures completely and can lead to overall weakness. The ruptured tendons can be repaired surgically or may be treated with conservative treatment measures depending on the severity of the condition.

Pain from gluteal tendon pathology is usually felt on the side of the hip, and the pain may be aggravated by walking, on elevated landscapes. Numerous patients complain of night pain, especially when lying on their sides. It is not uncommon for patients to develop a pronounced limp. Depending on the location and degree of damage, the symptoms and severity can vary. However, they are likely to include some of the following:

• Swelling
• Inflammation
• Difficulty sitting
• Pain in your buttocks
• Limping while walking
• Discomfort in rotating the hip
• Pain on the side of the hip
• Difficulty executing a hip range of motions
• Pain at night, interrupting sleep

Your physician may conduct some tests and investigations based on your signs and symptoms. In many cases, patients may have a combination of arthritis of the hip as well as gluteal pathology. Diagnostic tests are crucial for an effective treatment plan and some of the investigations include:

• A thorough review of your medical history
• Physical examination
• Imaging tests: Plain x-rays are convenient to rule out hip joint pathology. Further, it may provide some evidence of chronic bone changes at the site of tendon attachment.
• Diagnosis is often confirmed with ultrasound, CT, or MRI testing, as these may provide detailed and reliable information.

There are multiple treatment options for treating Gluteal Tendon tears. For some people, simple measures such as the use of analgesics, anti-inflammatory medication, physiotherapy, and use of walking aids can bring great relief and prolong the other treatment procedures. The second level of intervention includes the injection of cortisone or platelet-rich plasma. However, patients with severe tendon damage will need surgical repair. Your physician will assess your hip and advise you of the most appropriate treatment options. The Gluteal Tendon Repairs are performed in the following methods.

Endoscopic Gluteus Medius Repair: This is a “minimally-invasive” procedure involving three to four small incisions around the hip joint. A tiny camera is introduced to view the attachment site of the gluteus medius on a monitor. The hip bursae are minute fluid-filled sacs present between the moving parts in the joints, to reduce friction. Sometimes these hip bursae are inflamed or irritated due to infection or injury, known as “hip bursitis”. Such tissue is removed initially, and then depending on the type of tear, a full-thickness or partial-thickness tear, it is repaired with bone anchors into the greater trochanter and suture passed through the ruptured tendon. Your surgeon will then pull down the tendon to its normal anatomic position and tie it over the bone. You will be placed under general anesthesia or spinal anesthesia during the procedure and you will stay at least one night in the hospital.

Post-operative care: The recovery of the tendon repair will be depended on your pre-existing quality of the tendon and the measures to convalesce in the first 8 weeks after surgery. The following measures are recommended.

• You will be given medication to treat any pain or discomfort
• The repaired tendon should not be stressed for about 8 weeks
• You will be advised to use crutches till recovery
• Some patients will need physical therapy as part of rehabilitation
• You must take precautions to avoid a re-tear.
• Complete healing may take up to 4 months
• Exercises must be done to strengthen your hip
• You will be advised not to stand for long periods
• You may have to avoid lifting heavy items and climbing stairs.

Open Gluteus Medius Repair: In situations where the tear is determined to be chronic and retracted completely, an open procedure may be necessary. This would involve a large incision (8-cm) on the outside of your hip. The gluteus medius tendon is repaired with bone anchors into the great trochanter. The sutures are passed through the ruptured tendon, then pulled down to its normal anatomic position and tied over the bone. You will be placed under general anesthesia or spinal anesthesia during the procedure and you will stay 2-3 nights in the hospital.

Post Operation Care:

• After the operation, you must keep the wool and crepe bandages on for 24 hours.
• Keep wounds clean, dry, and covered for 2 weeks, until the wound is completely healed.
• Do not soak the incision until the wound is completely healed
• After your Gluteal Tendon Repair, a minimum of 12 weeks of rehabilitation will be necessary. The rehabilitation may involve proprioception exercises for progressive gluteal strengthening.

Every surgery has some risks and complications. Although Open Gluteus Medius Repair can be done with a minimally invasive procedure, which is generally a safe technique, some the possible complications may arise as listed below.

• Infection in the surgical wound
• Unattractive scarring
• Bleeding into the hip joint Infection
• Unexplained pain and discomfort
• Complex Regional Pain Syndrome
• Stiffness and loss of use of the arm and hand
• Damage to nerves
• Change in your gait characteristics
• Wound and/or deep joint infection
• Deep vein thrombosis (DVT)
• Fracture
• Nerve injury
• Component failure
• Revision surgery
• Heart attack
• Chest infection
• Pulmonary embolism
• Damage to tendons
• Intolerance to anesthetics and pain medication

The Gluteal Tendon repair aims to reduce hip pain, improve hip function and improve the overall quality of life and mobility. A minimally invasive procedure involves minimal scarring and a quicker recovery. The purpose of this surgery is to ensure that your hip retains good movement and muscle function. Furthermore, the surgery may restore the strength and function of the hip joint.