Preoperative Assessment and Postoperative Guidelines for Gluteus Tendon Repair Surgery

What does the process look like leading up to Gluteus Tendon Repair surgery?

Dr. Ramkumar has a detailed process and checklist to ensure your safety prior to undergoing gluteus tendon repair surgery, also known as abductor tendon repair surgery. During this surgery, Dr. Ramkumar repairs both the tendons of the gluteus medius and gluteus minimus. In cases where the tendon tear has been present for many years, a gluteus maximus tendon transfer is often performed simultaneously. Gluteus tendon repair surgery is a specialized operation that requires specialized attention. Once you have decided to proceed with surgery, we check the following:

• Walker: You must get this before surgery, but you do not need to bring it with you on the day of surgery. If you are struggling to acquire one in a timely fashion, you can purchase it through Amazon Prime HERE.  You will need to use this for the first two weeks minimum after joint replacement.

• Physical therapy appointment: if your insurance allows you to have home health care (not all do!), you should have that arranged before surgery. Otherwise, your goal is to walk with the walker every waking hour. You will need to set up outpatient therapy at three weeks postoperatively after Dr. Ramkumar has evaluated your wound at two weeks postoperatively.

• Medications: you need to have these picked up well before you check in to the hospital, as it will be highly unlikely and unreasonable to expect to acquire these homegoing medications close to or on your surgical date. Pharmacies often struggle with receiving electronic prescriptions and, depending on your insurance plan or surgery, require prior authorization – causing delays that frustrate everyone involved. If you don’t have your medications within 48 hours of your preoperative visit, you are expected to email info@premramkumar.com so we may help reconcile this issue where possible.

How do you address pain management and nausea after joint replacement/resurfacing surgery?

• We prefer to use spinal anesthesia. This helps control bleeding better during surgery and is associated with less pain medication consumption after surgery.
• We use an injection of pain medication directly into the hip at the time of surgery, to help keep the pain in the first 24-36 hours well controlled.
• We use multimodal pain medications while trying to minimize the use of narcotics. We typically use:
  • Dexamethasone (10mg) for two days after surgery,
  • Tylenol three times a day (never exceeding 4000mg in 24 hours) for the first month after surgery
  • Naproxen (500mg) twice daily for the first two weeks after surgery
  • Omeprazole (20mg) once a day while on an NSAID (Naproxen, Advil, or Melocixam)
  • Tramadol (50mg-100mg) every 8 hours for the first week after surgery for moderate pain
  • Hydromorphone/Dilaudid (2-4mg) every 4 hours for the first week after surgery for severe pain
  • Colace (100mg) twice a day while on narcotics (tramadol, hydromorphone)
  • Senna (8.6mg) twice a day while on narcotics (tramadol, hydromorphone)
• We use an anti-emetic to limit nausea, and it is critical you take this medication in the first week even if you don’t experience nausea
  • Ondansetron (4-8mg) for the first week of surgery
• We use a blood thinner to limit blood clots, and it is critical you take this medication in the first four weeks even if you feel fine
  • Typically Aspirin 81mg twice a day for four weeks
  • In rare occasions, we may use Apixaban/Eliquis depending on your history

How do you address swelling after joint replacement/resurfacing surgery?

Swelling is a very complex subject with many factors at play. Swelling certainly contributes to pain. However, after gluteus tendon repair surgery, swelling is expected and needed to allow the tendons to heal back down to bone. This can be present for up to three months, especially if a gluteus maximus tendon transfer is needed. Nonetheless, trying to reduce swelling postoperatively can be very helpful to reduce discomfort and allow you to move better. Postoperative swelling is variable because patients come into surgery with varying degrees of fitness (muscular strength, venous capacity) and tendon injury. Additionally, performing the actual operation involves adding significant fluid from irrigating debris and cleaning the joint.

1. If feasible, Dr. Ramkumar recommends purchasing the below tablets for you to take 5 days before surgery and 25 days after surgery.

DIOSMIN & HESPERIDIN

The above recommendation is backed by science, and you can read more here about it in the Journal of Bone and Joint Surgery.

How do you address performance and recovery after joint replacement/resurfacing surgery?

Performance and recovery is a very important subject to Dr. Ramkumar and many of his patients. In the context of gluteus tendon repair surgery, less is known and understood about this in comparison to his athletes recovering from less invasive, sports medicine procedures. With that being said, Dr. Ramkumar does want you to take the first two weeks after gluteus tendon repair slowly to maintain safety, control your pain, and avoid retear. Taking it slow does not mean you are compromising your performance! You can recover smart, and if feasible, please consider purchasing the below to take 5 days before surgery and 25 days after surgery with water.

XTEND ORIGINAL BCAA POWDER

The above recommendation is backed by science, and you can read more here about it in the Journal of Bone and Joint Surgery here and here.

Between all the medications and physical therapy, what do the first few days look like after joint replacement/resurfacing surgery?

Below is a table that has been designed as a guideline. If you do not have some medications listed here, you may ignore them or take as directed on your discharge instructions.

GENERIC (BRAND): Hydromorphone (Dilaudid), Acetaminophen (Tylenol), Omeprazole (Prilosec), Tramadol (Ultram), Naproxen (Aleve), Docusate (Colace), Sennosides (Senna), Ondansetron (Zofran), Dexamethasone (Decadron)

For redundancy:

• Dexamethasone (decadron) should be taken the first two days after surgery. Take with breakfast.
• Naproxen (if given) should only be used for two weeks. After it is finished, you may take over-the-counter Advil or Motrin instead.
• Zofran (ondansetron) is used for nausea as needed only.

What activities can I do right after Gluteus Tendon Repair surgery?

Dr. Ramkumar wants you to walk with 75% of your weight on the operative leg to start for the first two weeks. Thereafter, you can slowly progress to full weight bearing to your tolerance. You will need to use the walker at all times for balance and stability for 4-8 weeks after surgery. This broad variation depends on your personal readiness, your underlying physical fitness, your coexisting medical conditions, your physical therapy assessment, and Dr. Ramkumar’s assessment.

• You can do upper body exercises while seated.
• You can walk in a straight line as long or as far as you can tolerate.
  • Dr. Ramkumar does not want you changing direction quickly or cutting, as this excessive and sudden adduction or abduction may compromise the newly repaired tendon repair.
  • Dr. Ramkumar does not want you sitting with your legs crossed or rotating your leg to tie your shoelaces in the first 6 weeks.

On average it takes 3 months for the repair to fully consolidate 90% of the way. The last 10% takes a full year. However, after six weeks, Dr. Ramkumar wants you to start loading the repair in a supervised fashion to rebuild strength and proprioception alongside your physical therapist.

Is it safe to have an x-ray, CT scan, or MRI after my Gluteus Tendon Repair surgery?

Yes! You will still be safe to go through diagnostic testing in the future with your plastic anchors in your proximal femur. This anchor degrades over years, well beyond when the tendon has healed back down to the bone.  When you are traveling, you do not need worry about TSA machines flagging you for your Gluteus Tendon Repair surgery.

Is swelling and bruising after Gluteus Tendon Repair surgery normal?

Yes! Swelling is expected and necessary to allow the tendons to heal back down to bone. Inflammation causes pain and swelling, but it also enables healing. This can be present for up to three months, especially if a gluteus maximus tendon transfer is performed. Remember that if a gluteus maximus transfer is performed, the cosmesis of the buttocks will be asymmetric. This swelling and bruising can get a bit worse for a week or so after the operation. This bruising may be quite dark and may go from the thigh to the foot. In addition to bruising, there may be swelling of the area around the incision as well as the entire leg and foot. The swelling (especially in the foot and ankle) typically gets worse through the course of the day. Some of the swelling can be improved if the leg is elevated when you are laying down (putting the foot up on an ottoman or elevating your heel on multiple pillows while sitting on a couch). You may need to use 4-5 pillows to elevate your leg, and please elevate it above the level of your heart to reduce swelling. Please contact our office or report to local emergency room if there is extensive swelling, pain associated swelling, and/or trouble breathing. If there is calf pain, this can be a sign of a blood clot and your should let the office know or go to an urgent care/emergency room.

Is it normal to have sleep issues after Gluteus Tendon Repair surgery and what can I do about it?

Up to 85% of patients will experience some disturbance in their sleep pattern in the weeks following surgery. For example, difficulty falling asleep, staying asleep, or waking up too early are commonly reported. To deal with this sleep disturbance, we suggest you avoid caffeine after mid-day (this includes coffee, tea, and soda). Avoid taking “cat naps” and going to bed late in the evening (10:30-11:00pm or later). In certain cases, you may take a melatonin.

When can I shower after Gluteus Tendon Repair surgery?

You will likely have a sealed dressing on, so you can shower immediately after surgery. Dr. Ramkumar prefers you keep the thigh wrapped (trash bag, Saran wrap or Glad Press ‘n Seal) to avoid any incidental leaking if there is even a small break in the dressing seal. This dressing will be removed at the first postoperative visit in the office for personal evaluation of the incision. Come to the office during business hours at any time if you have any concerns with the integrity of the dressing, and one of our medical assistants will see you for a nursing visit the same day. After your first postoperative visit with Dr. Ramkumar, showering over the incision and their steri-strips with soap and water is fine, but do not directly scrub the surgical incision. You may pat the surgical area dry. The steri-strips will fall off on their own time, usually in 1-2 weeks after application. No submerging or bathing the incision until at least 6 weeks after surgery

When can I drive after Gluteus Tendon Repair surgery?

Patients usually feel comfortable to drive between 4-8 weeks after surgery. Dr. Ramkumar cannot formally know when you are safe to drive but he has the following criteria:

• No longer taking prescription narcotic medications such as Ultram, Dilaudid, Oxycodone
• Walking without a walker for a week.
• You feel comfortable enough to slam on the brake.