Extension-abduction contracture of the hip joint as a consequence of gluteal fibrosis

Introduction The disease that is manifested by primarily induced fibrotic changes in the gluteal muscles resulting in hip contractures and, in particular, in extension-abduction contracture of the hip joints has been known in the English literature as the “gluteal muscle contracture” and “gluteal fibrosis”. The world literature on the subject covers this pathology mostly in pediatric and adolescent patients, whereas this disease has not been sufficiently discussed in the adult patients, even in foreign studies. Therefore, diagnostic methods, methods of examination and treatment of adult patients have not been systematized and this nosology presents certain clinical and diagnostic difficulties for many domestic orthopedists. Materials and methods We searched the PubMed and eLibrary systems for studies on the topic and used combinations of key words “gluteus muscle contracture”, “gluteal fibrosis”, “gluteus maximus contracture”, “abduction contracture of the hip”, ”extension-abduction contracture of the hip”, “aplasia of gluteal muscles” published from October 1974 to February 2020 and found a total of 106 results. The first publication coincides with the date of the initial search period. The criteria for including studies in the analysis were a discussion of the issues of etiology and pathogenesis, epidemiology, diagnostic criteria, clinical presentation, and approaches to the treatment of this pathology. We excluded articles related to the installation of gluteal implants and other pathology of the gluteal region, so the number of articles decreased to 67, what means little investigation of this problem. Results Our analysis showed that out of 67 articles, only 9 articles were related to issues of etiology and pathogenesis, five articles dealt with epidemiology, 15 dealt with diagnostic criteria, treatment options were described in 12 articles, and the majority of publications focused on the results of surgical treatment of clinical samples including 1-2 to 1280 cases. In the context of the 50-year-old depth of the literature search, the analysis indicates the fragmentation of the material devoted to the gluteal muscle fibrosis published over this period of time, which requires the systematization and generalization of the literature data accumulated to date. Conclusion Gluteal fibrosis is a rare independent disease, which is prevalent among certain ethnic groups. The extension-abduction contracture of the hip joint develops due to gluteal fibrosis, the clinical picture of which has been very well documented and has specific radiological signs. Surgical treatment methods vary, from open to endoscopic treatments and minimally invasive techniques. Since the main group of patients described in the literature is children and adolescents and the surgical methods used are discussed for these age groups, treatment methods and their efficacy for adult patients have been little reported. Therefore solution making is difficult for patients older than 18 years. It primarily refers to providing specialized orthopedic care in places where ethnic groups with this pathology reside.

Clinical results of arthroscopic tight fibrous band release for adult moderate-to-severe gluteal fibrosis using anterior and posterior portals: a retrospective analysis of 118 consecutive cases

Background To evaluate the clinical outcomes of arthroscopic tight fibrous band release in the treatment of adult moderate-to-severe gluteal fibrosis using anterior and posterior portals during mid-term follow-up. Methods The data of 138 patients (58 males, 80 females) aged between 18 and 42 years (mean, 28.6 years), presenting with bilateral moderate-to-severe gluteal fibrosis (GF) from October 2013 to August 2019, was retrospectively analyzed. All patients underwent arthroscopic tight fibrous band release using anterior and posterior portals with radiofrequency energy. Under arthroscopic guidance through the posterior portal, we debrided the fatty tissue overlying the contracted band of the gluteal muscle and excised the contracted bands using a radiofrequency device introduced through the anterior portal. The pre- and post-operative gluteal muscle contracture disability (GD) scale and the patient satisfaction rate were compared to evaluate the curative effect of the operation. Results The average operation time was 18 min (range, 10–30 min) and the average blood loss was 4 ml (range, 2–10 ml) for unilateral arthroscopic release. Two cases of post-operative minimal hematomas, 2 cases of bruising and 2 cases of local subcutaneous edema were observed as early complications and were cured by conservative treatment. After surgery, all incisions healed in stage I, and no other complications such as wound infection, nerve and blood vessel injury were detected. One hundred eighteen patients were followed up for 6 to 72 months (mean, 36 months). No lateral instability of the hip was observed and all patients returned to normal gait. The degree of adduction of the hip joint in all these 118 patients was significantly improved relative to their pre-operative conditions. One hundred fifteen patients (97.5%) were able to crouch with knees close to each other after surgery. One hundred fourteen patients (96.6%) were able to cross the affected leg completely without any support. The GD scale was improved from 55.5 ± 10.6 before operation to 90.1 ± 5.2 at the last follow-up (p < 0.05). The patient satisfaction rate was 95.8%. Conclusion Arthroscopic tight fibrous band release using anterior and posterior portals is minimally invasive for adult moderate-to-severe gluteal fibrosis, with a high success rate, quick recovery after surgery and reliable medium-term effect.

Clinical results of arthroscopic tight fibrous band release for adult moderate-to-severe gluteal fibrosis using anterior and posterior portals ： a retrospective analysis of 118 consecutive cases

Background: To evaluate the clinical outcomes of arthroscopic tight fibrous band release in the treatment of adult moderate-to-severe gluteal fibrosis using anterior and posterior portals during mid-term follow-up. Methods: The data of 138 patients (58 males, 80 females) aged between 18 and 42 years (mean, 28.6 years), presenting with bilateral moderate-to-severe gluteal fibrosis (GF) from October 2013 to August 2019, was retrospectively analyzed. All patients underwent arthroscopic tight fibrous band release using anterior and posterior portals with radiofrequency energy. Under arthroscopic guidance through the posterior portal, we debrided the fatty tissue overlying the contracted band of the gluteal muscle and excised the contracted bands using a radiofrequency device introduced through the anterior portal. The pre- and post-operative gluteal muscle contracture disability (GD) scale and the patient satisfaction rate were compared to evaluate the curative effect of the operation. Results: The average operation time was 18 min (range, 10-30 min) and the average blood loss was 4 ml (range, 2-10 ml) for unilateral arthroscopic release. Two cases of post-operative minimal hematomas, 2 cases of bruising and 2 cases of local subcutaneous edema were observed as early complications and were cured by conservative treatment. After surgery, all incisions healed in stage I, and no other complications such as wound infection, nerve and blood vessel injury were detected. 118 patients were followed up for 6 to 72 months (mean, 36 months). No lateral instability of the hip was observed and all patients returned to normal gait. The degree of adduction of the hip joint in all these 118 patients was significantly improved relative to their pre-operative conditions. 115 patients (97.5%) were able to crouch with knees close to each other after surgery. 114 patients (96.6%) were able to cross the affected leg completely without any support. The GD scale was improved from 55.5±10.6 before operation to 90.1±5.2 at the last follow-up (p<0.05). The patient satisfaction rate was 95.8%. Conclusion: Arthroscopic tight fibrous band release using anterior and posterior portals is minimally invasive for adult moderate-to-severe gluteal fibrosis, with a high success rate, quick recovery after surgery and reliable medium-term effect.

Clinical results of arthroscopic tight fibrous band release for adult moderate-to-severe gluteal fibrosis using anterior and posterior portal: a retrospective analysis of 118 consecutive cases

Background To evaluate the clinical outcomes of arthroscopic tight fibrous band release in the treatment of adult moderate-to-severe gluteal fibrosis using anterior and posterior portals during medium and long-term follow-ups. Methods The data of 138 patients (58 males, 80 females) aged between 18 and 42 years (mean, 28.6 years), presenting with bilateral moderate-to-severe gluteal fibrosis (GF) from October 2013 to August 2019, was retrospectively analyzed. All patients underwent arthroscopic tight fibrous band release using anterior and posterior portals with radiofrequency energy. Under arthroscopic guidance through the posterior portal, we debrided the fatty tissue overlying the contracted band of the gluteal muscle and excised the contracted bands using a radiofrequency device introduced through the anterior portal. The pre- and post-operative gluteal muscle contracture disability (GD) scale and the patient satisfaction rate were compared to evaluate the curative effect of the operation. Results The average operation time was 18 min (range, 10–30 min) and the average blood loss was 4 ml (range, 2–10 ml) for unilateral arthroscopic release. Two cases of post-operative minimal hematomas, 2 cases of bruising and 2 cases of local subcutaneous edema were observed as early complications and were cured by conservative treatment. After surgery, all incisions healed in stage I, and no other complications such as wound infection, nerve and blood vessel injury were detected. 118 patients were followed up for 6 to 72 months (mean, 36 months). No lateral instability of the hip was observed and all patients returned to normal gait. The degree of adduction of the hip joint in all these 118 patients was significantly improved relative to their pre-operative conditions. 115 patients (97.5%) were able to crouch with knees close to each other after surgery. 114 patients (96.6%) were able to cross the affected leg completely without any support. The GD scale was improved from 55.5 ± 10.6 before operation to 90.1 ± 5.2 at the last follow-up (p < 0.05). The patient satisfaction rate was 95.8%. Conclusion Arthroscopic tight fibrous band release using anterior and posterior portals is minimally invasive for adult moderate-to-severe gluteal fibrosis, with a high success rate, quick recovery after surgery and reliable medium- and long-term effect.

MRI FINDINGS IN IDIOPATHIC GLUTEAL FIBROSIS

Gluteal fibrosis is usually secondary to intramuscular injections and rarely can be idiopathic in nature. Clinically characterized by proximal muscle weakness and in advanced cases groove can be seen in gluteal regions. It can mimic with other conditions like muscular dystrophies and poliomyelitis. MRI is a very valuable tool in diagnosing this disorder and is also helpful to exclude other conditions.