JOA - 2026-05-18 - Journal Article
Clinical, Radiological, and Kinematic Impact of Gluteus Maximus Tendon Release During Total Hip Arthroplasty: A Prospective Randomized Controlled Trial.
Naldöven ÖF, Çepni Ş, Veizi E, Duran S, Ordu Gökkaya NK, Koç SS, Fırat A, Kılıçarslan K
Topics
Key Takeaway
Gluteus maximus tendon release during THA reduces muscle density (11.5 to 9.0 HU, p=0.022) but does not impair isokinetic extensor strength or clinical outcomes compared to preservation or release-with-repair at short-term follow-up.
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Summary
This RCT randomized 144 THA patients into three groups—tendon preserved, released, or released-and-repaired—to determine whether gluteus maximus tendon release causes gluteal dysfunction. CT-measured muscle cross-sectional area and isokinetic extensor strength did not differ among groups at final follow-up. Only the release group demonstrated a statistically significant decline in muscle density (11.5 vs 9.0 HU, p=0.022), with no between-group differences in VAS, Harris Hip Score, or WOMAC.
Key Limitation
Follow-up duration is not explicitly defined, precluding conclusions about whether the muscle density reduction in the release group is reversible or progresses to clinically meaningful atrophy over time.
Original Abstract
BACKGROUND
Release of the gluteus maximus tendon during a total hip arthroplasty (THA) can lead to gluteal dysfunction. Sciatic nerve injury, while rare, remains a serious complication of THA. During deep hip flexion, release of the tendon increases the distance between the femoral neck and the sciatic nerve, potentially reducing the risk of nerve injury. The functional consequences of such a release have yet to be investigated. The aim of this study was to evaluate the effects of gluteus maximus tendon release on the development of gluteal dysfunction using clinical, radiological, and kinematic measurements.
METHODS
Between September 2023 and August 2024, 144 patients undergoing THA were prospectively randomized into three groups: (1) gluteal tendon preserved, (2) gluteal tendon released, and (3) gluteal tendon released and repaired. All patients received a standardized surgical and rehabilitation protocol. Clinical outcomes were assessed using a Visual Analog Scale, Harris Hip Score, and the Western Ontario and McMaster Universities Osteoarthritis Index scores, radiological evaluation included cross-sectional area and density of the gluteus maximus muscle on computed tomography, and kinematic analysis measured isokinetic hip extensor strength.
RESULTS
Postoperative clinical scores significantly improved in all groups. There were no differences among groups in muscle cross-sectional area or extensor strength at the final analysis. However, a significant decrease in muscle density was observed only in the gluteal tendon release group (11.5 ± 15.0 preoperatively versus 9.0 ± 16.6 HU (Hounsfield unit) postoperatively, P = 0.022). The incidence of sciatic nerve complications was low and similar among groups.
CONCLUSION
Gluteus maximus tendon release does not negatively affect postoperative muscle strength or clinical outcomes, but may lead to reduced muscle density. Tendon release may be considered in hips with limited exposure or high risk of sciatic nerve injury. Preservation or repair of the tendon is recommended when feasible.