Gluteus Medius Repair — Arthroscopic Gluteus Medius Repair

Orthopedic & Sports Medicine Specialists (OSMS)

Weight-Bearing

FFWB through wk 5; PWB progressing to ~50% bodyweight by end of wk 6 with bilateral crutches/walker; WBAT with AD after wk 6; unilateral crutch/cane possible at wk 7

Key Restrictions

PROM restrictions: ER 0 deg x6 wks, adduction 0 deg x6 wks, extension 0 deg x4 wks, abduction 25-30 deg x3 wks then as tolerated, IR 0 deg x4 wks, flexion gradually past 90 deg after 3 wks; avoid pushing aggressively through pain/pinching; ROM must precede strengthening; S/L hip abduction not before wk 10; no contact or impact activities until MD release

Timeline & Phases

Phase I, Immediate Rehabilitation (wks 1-4, begin POD 1-7): protect repaired tissue, restore ROM within guidelines, prevent muscular inhibition/gait abnormalities, diminish pain/inflammation, caregiver circumduction 1x/day; wks 1-3: PROM within guidelines (long axis traction with circumduction/abduction, PROM flexion pain/pinch-free), hamstring stretch, single knee to chest, quad sets, ankle pumps, glute sets 25% effort, transverse abdominal activation, hip adduction isometrics, stationary bike without resistance at 3 wks, scar massage/STM to iliopsoas/TFL/ITB/adductors/QL/paraspinals (avoid gluteus medius tendon); wks 4-5: add IR/extension PROM, hip flexor stretch off table edge, sub-max hip flexion, quad/hamstring isotonics, sub-max hip abduction isometrics wk 4, begin PWB (max 50% BW) with bilateral crutches/walker at wk 5; Phase II, Intermediate Rehabilitation (wks 6-12, criteria: low pain, minimal irritation, appropriate ROM progression): restore full hip ROM before strengthening, restore normal gait with AD discharge goal ~8-10 wks, progressive hip/pelvis/LE strengthening for ADLs; initiate ER PROM at wk 6, prone IR/ER and BKFO stretches at wk 6, progress to FWB before full WB strengthening, stationary bike resistance increase (elliptical at wk 10), core stabilization, hamstring curls, LAQ, bridges, shallow mini-squats, step-ups, standing hip abduction/extension, clamshells, single leg balance, lateral step-ups, non-resisted sidesteps, eccentric tap downs, S/L hip abduction no sooner than wk 10; Phase III, Advanced Rehabilitation (wks 12-16, criteria: full ROM, pain-free normal gait, hip flexor/glut med strength >=4/5, hip add/ext/IR/ER strength >=4+/5): maintain ROM/flexibility, progress core/hip/LE strength and endurance with functional focus, increase gluteus medius strengthening (resisted side steps, lateral movements, wall squats, multi-angle lunges), advanced single leg balance/core, deadlift, pelvic drop, side bridge/plank; no contact or impact activities until MD release

Notes

OSMS Rehabilitation Guidelines; protocol adopted with permission from Dr. Laskovski; separate OSMS protocols exist for labral repair variants (capsular repair/closure, capsular plication, capsulotomy) and iliopsoas lengthening — if gluteus medius/minimus repair also performed, follow this more restrictive protocol instead of labral repair protocol; FFWB defined as foot-flat without bearing weight to avoid anterior hip irritation from holding hip in flexion