The gluteus medius is located on the outer surface of the hip, stabilizing the pelvis and hip during movement, particularly walking. Its tendon attaches to the greater trochanter of the femur (thigh bone). When a chronic tear does not heal with non-surgical treatments, surgical repair is necessary to reattach the tendon to the bone. This procedure restores muscle function, reduces chronic pain, and improves hip joint stability.
Managing the Initial Post-Surgical Phase
The first four weeks following gluteus medius tendon repair focus on protecting the surgical site and managing discomfort. Immediately after the operation, patients experience moderate pain, controlled initially with medication for the first two to three days. As the nerve block wears off, pain management transitions to over-the-counter relievers like acetaminophen, often combined with anti-inflammatory medications if prescribed. Cold therapy, such as an ice machine, should be used frequently for the first three to four weeks to minimize swelling and local pain.
Wound care in the first week involves monitoring the incision sites for normal drainage, which may appear as a blood-tinged, pinkish-yellow fluid. Patients must keep the surgical dressing clean and dry, following specific instructions for showering. Soaking the incision in a bath or pool is strictly avoided for approximately four weeks. Stitches or staples are typically removed at the first post-operative visit, usually one to two weeks after the procedure.
Initial mobility is heavily restricted to protect the healing tendon, as the repair site is most vulnerable during this period. Patients are typically non-weight-bearing or limited to toe-touch weight-bearing (about 20 pounds) on the operative leg for the first six weeks, requiring crutches or a walker for all movement. A hip brace is often prescribed to be worn constantly, including while sleeping, to prevent specific movements that could strain the repair, such as excessive hip flexion beyond 90 degrees or abduction.
The Phased Rehabilitation Program
Physical therapy is a structured, multi-phase program that begins soon after surgery and is fundamental to a successful outcome. Recovery is criterion-based, meaning progression depends on meeting specific physical goals rather than reaching a calendar date. The focus of the program is to gradually restore strength and range of motion while strictly adhering to precautions that protect the tendon reattachment.
Phase 1: Protection and Passive Range of Motion
The first phase, typically lasting from day one through six weeks, centers on protecting the repaired tendon. Goals include maintaining the integrity of the repair, managing swelling, and beginning passive range of motion (PROM) exercises. Passive movements, where a therapist moves the leg without the patient using the gluteal muscles, are performed cautiously to prevent stiffness. Exercise concentrates on gentle movements like ankle pumps, quadriceps sets, and gluteal sets to promote circulation. Precautions include limiting hip flexion to 90 degrees and avoiding any active contraction of the gluteus medius muscle, such as lifting the leg sideways, which could pull on the healing tendon.
Phase 2: Active Strengthening
Phase two generally starts around six to eight weeks post-operation, marking the transition to active engagement of the repaired muscle. Once the surgeon clears the patient for weight-bearing, the focus shifts to normalizing the gait pattern and initiating active range of motion (AROM) exercises. Exercises progress from passive to active-assisted and then to light active movements, such as supine hip abduction slides and standing hip extension. Low-resistance activities, like using a stationary bike with a high seat to maintain the hip flexion limit, are introduced to improve cardiovascular endurance and controlled motion.
Phase 3: Advanced Conditioning
The final stage of formal physical therapy starts around three to four months, focusing on advanced conditioning, balance, and preparing the hip for higher functional demands. This phase introduces more challenging closed-chain exercises, where the foot is fixed on the ground, such as mini-squats and leg presses. The program incorporates functional movements like lunges, side-stepping with resistance bands, and single-leg stance exercises to maximize strength, balance, and proprioception. The goal is to restore power and endurance to the gluteal muscles, allowing a safe return to all desired activities, which may take up to nine months or more.
Functional Milestones and Activity Timelines
A patient’s ability to return to specific daily activities is a key measure of recovery, dictated by the biological healing of the tendon. The initial toe-touch weight-bearing restriction is typically lifted at six to eight weeks post-surgery, allowing a gradual transition to full weight-bearing as tolerated. The goal is to wean off crutches entirely and normalize the gait pattern, which may take up to 12 weeks to achieve without a noticeable limp.
Return to driving is often possible once the patient is off narcotic pain medication and can use the surgical leg safely for braking, which may take six weeks or longer. Sedentary work, such as an office job, can often be resumed within a few days to two weeks after surgery, depending on comfort. A return to physically demanding work or heavy labor is significantly delayed and determined individually by the surgeon, aligning with the advanced conditioning phase.
Low-impact recreational activities are integrated earlier, often around the three-month mark. Swimming and cycling on a stationary bike (with appropriate seat height) are common low-impact options introduced after the initial protection phase. The return to higher-impact activities, such as running or sports requiring jumping and cutting, is a much later milestone, often not advised until six to nine months post-operation and only after successful completion of a functional performance test.
Recognizing Potential Complications
While gluteus medius tendon repair is generally successful, patients must be aware of warning signs that distinguish normal discomfort from a serious complication. Signs of infection at the surgical site include increasing redness, warmth, swelling, a foul odor, or pus-like drainage, particularly if accompanied by a persistent fever. These symptoms warrant immediate medical attention, as infection can severely compromise the healing process.
Patients are also at risk for developing a deep vein thrombosis (DVT), a blood clot in the leg, due to reduced mobility after surgery. Symptoms of DVT include sudden, increasing pain, warmth, or significant swelling in the calf or thigh that does not subside with elevation. Prophylactic measures, such as taking a blood-thinning medication like aspirin after surgery, are commonly prescribed to mitigate this risk.
Sudden, sharp, or unrelenting pain, especially if it occurs after a period of improvement or following a specific movement, could indicate a potential re-tear of the repaired tendon or a hardware issue. An inability to bear weight after being cleared to do so is another serious sign requiring immediate evaluation. Persistent or worsening nerve symptoms, such as numbness, tingling, or weakness in the leg, should also be reported to the surgical team promptly.