SURGICAL MANAGEMENT OF LIMITATION OF MOTION DUE TO CONTRACTURE OF GLUTEUS MAXIMUS

The congenital or acquired contracture of gluteus maximus is relatively rare, and its clinical feature of chronic lower back pain and extension contracture of the hip joint had been confused with herniations of lumbar disc disease or sequelae of cerebral palsy. The authors successfully treated these contracture of gluteus maximus, so report these cases and results. 9 patients suffering from Difficulty in squatting position or gait disturbance were surgically treated in our department from 1979 to 2000. There were eight men and a woman, mean age was 17.3 years old, and seven patients were bilateral. Four patients revealed past medical history of multiple intramuscular injection at gluteal region, but five patients revealed unremarkable history. Preoperative mean further flexion, internal rotation and external rotation of hip joint were 42°, 15°, and −5°. These patients revealed specific features of frog leg position in squatting position. Intraoperatively, the authors released the fibrotic band of the gluteus maximus, the short external rotators, the gluteal attachment of the iliotibial band and the joint capsule. After anesthesiologic recovery, active and passive joint motion exercise of flexion and rotation was started to prevent recurrence of contracture. Postoperatively, mean further flexion of hip joint were increased to 105°, and no Difficulty in sitting or squatting position, but slight limitation in rotation was remained. In follow up visit, no decrease of articular motion were observed. Conclusively, severe limitation of joint motion due to contracture of gluteus maximus can be successfully treated with surgical maneuver accompanied with postoperative aggressive physical therapy.