Abstract
Background: Hip abductor deficiency is a common cause of lateral hip pain in middle-aged patients, and may be associated with muscle atrophy. Identifying upstream muscle denervation in the lumbosacral spine could potentially impact management of patients with abductor deficiency. The purpose of this study was to estimate the prevalence of lower lumbosacral pathology (L4-S1) in patients undergoing hip abductor tendon repair. Methods: All cases of primary hip abductor repair performed at a single tertiary care center between January 2010 and October 2022 were retrospectively reviewed. Demographic, perioperative and clinical data were obtained from the electronic medical record. Each subject was classified into the following groups: A) Confirmed L4-S1 disease based on preoperative or perioperative L4-S1 interventions (i.e., surgery, epidural injections, and/or EMG evidence of ipsilateral L4-S1 radiculopathy); B) Radiographic evidence based on dedicated lumbar spine MRI demonstrating nerve compression at L4-S1; C) No indication of L4-S1 disease based on prior interventions or MRI. Results: 131 cases of primary hip abductor repair were included. Over 80% of the patients were female, with a mean age of 64 years (range: 20-85). Thirteen patients (9.9%) underwent concomitant total hip arthroplasty and 25 patients (19.1%) underwent concomitant gluteus maximus transfer. Twenty-nine percent (n=38) of patients were categorized into group A, 12% (n=16) into group B, and 59% (n=77) into group C. Patients with L4-S1 pathology were statistically older than patients without L4-S1 pathology (p = 0.004). Fifty-four percent of patients undergoing concomitant THA and hip abductor repair demonstrated evidence of lumbosacral spine pathology. Conclusions: Over 40% of patients undergoing isolated hip abductor tendon repair and >50% of patients undergoing hip abductor tendon repair at the time of total hip arthroplasty demonstrated evidence of L4-S1 disease perioperatively. Patients with symptomatic hip abductor deficiency should be screened for concomitant lower lumbosacral spine pathology.