Introduction
The gluteal tendons attach to the bony prominence at the side of your hip. These tendons are important for normal walking and if they are not functioning well, it is not only painful but makes walking more difficult because much more energy is required to get around.
Indications
A reconstruction is recommended when your hip tendons have separated from their bony attachment – the greater trochanter. When this happens, it creates a lot of pain on the lateral side of your thigh due to the loose tendon rubbing on their normal bony attachment. Pain, weakness and a limp all follow and this can create considerable restriction in your mobility. The operation is designed to reattach these tendons to where they belong.
Preoperative Instructions
Because it will be necessary to protect your weight-bearing after the surgery for the first five to six weeks, it is a good idea to practice on your chosen walking aid (crutches – either type; normal or Canadian) or a walking frame. This will give the tendon time to heal onto the bone and it is essential to the success of the operation for this to happen. Coming into hospital proficient in the use of waking aids not only speeds up your recovery but also helps to train your upper body strength for when you really need it. Otherwise it is important to stay as mobile as you can before your admission.
Procedure
The operation is a reasonably big procedure as is any operation involving a large joint like the hip. The tendon is exposed and the damaged area is removed leaving a clean healthy tendon surface. Then the bone surface is prepared and the tendon is reattached by sutures passed through multiple tunnels in the bone. The hospital stay is generally three to four days.
Postoperative Instructions
In the immediate post-operative period, you will be using sequential calf compression to reduce the risk of a blood clot and be started on aspirin as well. Antibiotics are administered in the operating room. You will be given an incentive spirometer to exercise your lungs to keep your chest clear while you require strong pain medication. You wound is closed with absorbable staples so after 10 – 14 days you may take your water proof dressing off, wash the wound in the shower and remove the steri-strips. After that you may leave the dressing off and let the wound dry out.
After leaving hospital, arrangements can be made for you to go to a specialist rehabilitation centre. If you need to go to a rehabilitation center, this will be organized while in hospital and will be at a hospital close to your home. Most patients are well enough to go straight home. While weight-bearing on the leg is not advised, it is desirable that you move around as much as possible on the walking aid to maintain good muscle tone. After five weeks, weight-bearing commences by graduating 25% weight and then at six weeks to one crutch on the opposite side of the operation, then onto a stick and finally full weight-bearing. The best exercise by far to train your hip muscles is walking on flat ground. However, physiotherapy, hydrotherapy and a dedicated home exercise programme will help to restore your normal tendon and muscle function more quickly. Initially the muscles become quite sore because they are weak and unfit but this improves with regular exercises.
Risks
All surgeries have risks and the bigger the operation the more is the risk. The important problems for which strenuous precautions are taken in the peri-operative period are blood clots in the legs and less frequently in the lungs (pulmonary embolus), infection of the wound, nerve injuries. This is not all that can happen but would be the problems that occur directly related to the surgery. Exacerbations of pre-existing health problems which affect you such as heart arrhythmias, diabetes, strokes or gout can be made worse. It is essential in your pre-operative visit to mention any of these problems you may have so all precautions can be taken to minimise any risks from them.
Expected outcomes
Even long-standing “bursitis” pain can be relieved by surgery. Our longest duration of pain has been 180 months (15 years) and this patient was rendered pain free after the repair.
Treatment Alternatives
By the time the decision is made to proceed to surgery, you will have tried many non-operative treatments such as injections, physiotherapy and chiropractic and to be considered for an operation, none of these modalities will have been effective. Essentially this is a mechanical problem in your tendons so the only real treatment is to reattach them to the bone.