Comparing THA anterior and posterior approaches for gluteus medius repair: outcomes at a minimum 2-year follow-up
Author(s):Quesada-Jimenez R, Rana K, Wallace IA, Kahana-Rojkind AH, Domb BG.
DOI Link: 10.1177/11207000251394164
Background
Gluteus medius (GM) tears identified at the time of total hip arthroplasty (THA) can be addressed concurrently with either a direct anterior approach (DAA) or posterior approach (PA). However, comparative data evaluating how surgical approach influences outcomes after concomitant GM repair remain limited.
Methods
This Level 3 retrospective matched cohort study reviewed patients undergoing THA with concomitant GM repair from 2010 to 2022. Patients were included if they had preoperative and minimum 2-year follow-up data or documented endpoint (revision surgery). Patients were stratified by surgical approach (DAA vs PA) and propensity matched 1:1 based on age, sex, BMI, follow-up duration, and GM tear severity (<50%, >50%, or full thickness). Outcomes included validated PROs (mHHS, HHS, HOOS-JR, FJS, VAS), patient satisfaction, clinically relevant threshold achievement, and revision rates.
Key Findings
A total of 52 hips (26 DAA, 26 PA) were included. Both cohorts demonstrated significant improvement across all PROs at ≥2 years (P < .01).
No statistically significant differences were observed between DAA and PA groups for:
- Postoperative PRO scores across all measures (P > .05)
- Forgotten Joint Score (P = .72)
- Patient satisfaction (P = .56)
- MCID/PASS achievement rates
- Revision surgery rates
Both approaches yielded comparable functional improvement and survivorship.
Conclusion
THA with concomitant gluteus medius repair results in significant and durable clinical improvement, with no differences in outcomes or survivorship between direct anterior and posterior surgical approaches at short-term follow-up.
What Does This Mean for Providers?
When performing THA with concomitant GM repair, surgical approach (DAA vs PA) does not appear to influence midterm outcomes, patient satisfaction, or revision risk. Approach selection can therefore remain guided by surgeon expertise, exposure preference, and patient-specific anatomic considerations rather than expected differences in GM repair outcomes.