Patient Education · Hip

Gluteus Medius Repair

Sometimes called the rotator cuff of the hip — and like the shoulder version, it gets called bursitis for years before anyone looks properly.

Dr. Darin W. Allred Darin W. Allred, MD Board-certified orthopedic surgery & sports medicine
~1.5 hrsTypical time for the operation
6 weeksToe-touch weight bearing with a brace
Not bursitisThe tendon is torn, not just inflamed
6–12 moFull strength returns slowly

What these muscles do

On the outside of your hip sit the gluteus medius and minimus. Their tendons attach onto the bony point you can feel on the side of your hip.

Their job is not obvious until it fails. Every time you stand on one leg — which is every step you take — these muscles hold your pelvis level. Without them your pelvis drops toward the other side and you walk with a lurch.

Why it gets called bursitis for years

The pain sits on the outside of the hip, over that bony point. It hurts to lie on that side at night, to walk uphill, to climb stairs, and to stand on that leg. There is often a bursa inflamed on top of the tendon — so the label "trochanteric bursitis" fits the pain map perfectly.

The trouble is that the bursitis is frequently a symptom rather than the disease. Underneath it the tendon is frayed or torn off the bone, in exactly the way a rotator cuff tears at the shoulder.

People get injections that help for a while, then stop helping. Meanwhile the tear enlarges and the muscle thins. The tell that this is more than bursitis is weakness: real difficulty standing on that leg, a limp that others notice, or the pelvis dropping when you try.

It is most common in women over 50, and it is genuinely underdiagnosed. If you have had "hip bursitis" for two years and it has never resolved, the tendon deserves a proper look with an MRI.

What we try first

  • Targeted strengthening. Loading the tendon progressively, which is the same principle that works for other tendon problems.
  • Activity adjustments and avoiding the positions that compress the tendon — crossing the legs, standing hip-out, sleeping directly on that side.
  • An injection, which can settle an inflamed bursa. Useful, but repeated steroid around a tendon is not harmless, and I am cautious about doing it many times.

I move toward repair when there is a real tear on imaging with real weakness, and months of good rehabilitation have not turned it around.

How the operation goes

  1. Anesthesia. General or spinal, lying on your side.
  2. Reach the tendon through a small incision or through arthroscopic portals, depending on the tear.
  3. Remove the inflamed bursa and assess the tendon properly — the first time anyone has actually seen it.
  4. Prepare the footprint on the bone where the tendon belongs.
  5. Anchor and tie. Suture anchors set into the bone pull the tendon back down onto its footprint under compression, the same principle as a rotator cuff repair.
  6. Release the tight band running over the outside of the hip if it is contributing, which reduces the pressure on the repair.

Recovery

The repair fails in two ways: putting weight through it, and using the very muscle that was just reattached. So for six weeks we take away both.

  • Weeks 0–6Toe-touch weight bearing with a brace and crutches — the foot rests flat for balance but does not take load. No actively lifting the leg out to the side, and no letting it fall across your body. Therapy starts within the first few days, then about once a week. Sleep with a pillow between your knees. Aspirin 81 mg twice daily for two weeks.
  • Weeks 6–8Weight builds toward full, crutches come away, and the walking pattern is rebuilt deliberately — the limp is a habit as well as a weakness.
  • 2–6 monthsProgressive strengthening of the hip abductors. This is the long part. The muscle has usually been weak for years before surgery, and rebuilding it takes far longer than healing the tendon does.
  • 6–12 monthsContinued strength gains. Most people notice steady improvement well past the six-month mark.

The risks, honestly

  • The repair does not heal As with the shoulder, this depends on the tendon. A long-standing tear with thinned, fatty muscle on the MRI heals less reliably than a smaller, fresher one — another reason not to spend three years treating it as bursitis.
  • Persistent weakness or a limp If the muscle was severely wasted beforehand, reattaching the tendon does not automatically restore power.
  • Ongoing lateral hip pain Some tenderness over the area can persist for months.
  • Blood clots A real consideration with six weeks of protected weight bearing.
  • Infection Uncommon.
  • Numbness beside the incision Common and usually fades.
This page is general education. It describes how I approach this and what most patients experience. If anything here does not match what you were told in clinic, ask — your own instructions always come first.