Surgical Release of Gluteus Maximus Muscle Fibrosis and Its Effect on Hip Function

Abstract

Objective: To assess the functional and surgical outcomes of the surgical release of gluteus maximus muscle fibrosis by open conventional technique and to assess its effect on hip joint function. Methods: This study followed a group of cases for 20 months, from November 1, 2022, to June 30, 2024. The case study included ten patients with the diagnosis of GF who were treated surgically in the Department of Orthopedics in Al-Hussein Medical City in Karbala. The study included patients Under 18 years old with moderate (level II) or serious (level III) gluteal fibrosis (GF). And excluded patients with mild (level I) gluteal fibrosis according to Zhao et al.'s classification. Any past or current conditions that affect the hip, such as hip dysplasia, septic arthritis, slipped capital femoral epiphysis, or Legg-Calve-Perthes disease. Past injuries or surgeries to the hip or spine that might impact how the hip moves. The patients have a mental illness that prevents them from following instructions. Patients with neurological diseases that limit hip movement. And patients with a history of frequent muscle injections. Results: Sample's characteristics: The study involved 10 patients with bilateral GF, of which six were men. The participants' ages ranged from 6 to 13 years, with a mean age of 9.8 years. Of the 20 hips examined, 11 were classified as Level III MA GF, while 9 were classified as Level II MA GF. Functional evaluation: Before surgery, all 20 hips had low usable functional scores, with an average score of 3.6. In the follow-up after surgery, there was a noticeable change in how well patients were doing, with all of them achieving great results, averaging a functional score of 9.7. The p-value was under 0.001, which shows this result is very significant. Range of motion: After surgery, there were notable improvements in movement. The average range of motion improved from -3.6 degrees to 21.2 degrees for abduction, with a p-value of less than 0.001. For flexion, it went from 112.9 degrees to 120.3 degrees, also with a p-value of less than 0.001. The surgical outcomes: The results show that 15 hips (75%) had great surgical outcomes, while 5 hips (25%) had good surgical outcomes based on Lui et al.'s criteria. Conclusions: Surgery to release the tight band in the gluteal muscle using a standard open method can lead to great functionality, good to excellent results from the surgery, and a noticeable increase in range of motion (ROM). Patients with moderate to severe GF (class II and III according to Zhao et al classification) would mostly benefit from this procedure and are good candidates for it.