What is Gluteus Maximus Transfer?
Gluteus maximus transfer, also referred to as gluteus maximus flap transfer (GMT), is a surgical technique to treat severe pain, limp, and instability associated with loss of the abductor portions of the gluteus medius and gluteus minimus muscles of the hip secondary to total hip arthroplasty or primary abductor disruption. The procedure involves the transfer of a gluteus maximus muscle flap and tensor fascia lata (TFL) to the greater trochanter to substitute for the loss of abductor portions of the gluteus medius and minimus hip muscles and treat the associated hip abductor deficiency. Hip abductors are a major group of muscles found in the buttocks and include the gluteus maximus, gluteus medius, gluteus minimus, and tensor fascia lata muscles.
Anatomy of the Gluteal Muscles
The gluteal muscles are a group of 3 muscles (gluteus medius, gluteus minimus, and gluteus maximus) that form the buttock region and are necessary for the stability and movement of the hip joints. The tendons of two gluteal muscles (gluteus medius and gluteal minimus) are attached at the outer hip region and are often called the “rotator cuff of the hip.” Since these gluteal muscles are involved in abduction (movement of your leg away from the body's midline), any injury or tear due to various reasons can seriously affect the functional outcome of the hip.
Indications for Gluteus Maximus Transfer
Gluteus maximus transfer surgery is indicated when conservative treatment measures such as medications and physical therapy have failed to provide symptomatic relief from the avulsion of the abductor muscles of the hip.
Preparation for Gluteus Maximus Transfer
In general, preparation for gluteus maximus transfer will involve the following steps:
- A review of your medical history and a physical examination to check for any medical issues that need to be addressed prior to surgery.
- Diagnostic tests such as blood work and imaging to help detect any abnormalities that could compromise the safety of the procedure.
- Disclosing information about any allergies to medications, anesthesia, or latex.
- You should inform your doctor of any medications or supplements you are taking or any conditions you have such as heart or lung disease.
- You may be asked to stop taking blood thinners, anti-inflammatories, aspirin, or other supplements for a week or two.
- You should refrain from alcohol and tobacco at least a few days prior to surgery and several weeks after, as it can hinder the healing process.
- You should not consume solids or liquids at least 8 hours before surgery.
- You should arrange for someone to drive you home after surgery.
- A signed informed consent form will be obtained from you after the pros and cons of the surgery have been explained.
Procedure for Gluteus Maximus Transfer
In general, gluteus maximus transfer surgery will involve the following steps:
- The procedure is performed under general and/or regional anesthesia with you lying either in a supine (face-up) or lateral-decubitus position.
- The skin around your hip joint is sterilized with an antiseptic solution, and a 6- to 8-inch incision is made directly over the hip joint area.
- As part of obtaining the gluteus maximus muscle flap for transfer, adult cadaver specimens of the gluteus maximus flap were dissected to establish blood and nerve supply point of entry in the gluteus maximus and tensor fascia lata and evaluated for the safety and feasibility of transferring these muscles.
- The anterior segment of the gluteus maximus and the whole of the tensor fascia lata are then mobilized and transferred to the greater trochanter area of the hip such that the muscle fiber direction of the transferred muscles closely matches that of the damaged part of the gluteus medius and minimus to substitute for abductor deficiency.
- The joint is checked through its range of motion, and the operative area is cleaned with a sterile solution.
- The incision is closed through the deep soft tissues and the skin with dissolvable sutures, and a sterile dressing is applied.
Postoperative Care and Recovery
In general, postoperative care and recovery after gluteus maximus transfer will involve the following steps:
- You will be transferred to the recovery area where your nurse will closely observe you for allergic/anesthetic reactions and monitor your vital signs.
- You may experience pain, swelling, and discomfort in the hip area. Pain and anti-inflammatory medications are provided as needed to address these.
- Antibiotics are also prescribed to address the risk of surgery-related infection.
- You may also apply ice packs on the hip area to help reduce swelling and pain.
- You will be placed on assistive devices such as crutches with instructions on restricted weight-bearing for a defined period of time. You are encouraged to walk with assistance as frequently as possible to prevent blood clots.
- Instructions on incision site care and bathing will be provided to keep the wound clean and dry.
- Refrain from strenuous activities and lifting heavy weights for at least a couple of months. A gradual increase in activities is recommended.
- An individualized physical therapy protocol is designed to help strengthen your hip muscles and optimize hip function.
- You will be able to resume your normal daily activities in 3 to 4 weeks, but with certain activity restrictions. Return to sports may take 6 months or longer.
- Refrain from driving until you are fully fit and receive your doctor’s consent.
- A periodic follow-up appointment will be scheduled to monitor your progress.
Risks and Complications
Gluteus maximus transfer is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as the following:
- Damage to nerves and vessels
- Thromboembolism or blood clots
- Adverse reactions to anesthesia
- Hemarthrosis (bleeding inside the joint)
- Failure to relieve pain, instability, or improve gait kinematics and kinetics