Immediate Effects of Ultrasound-Guided Superior Gluteal Nerve-Targeted Manual Therapy and Exercise on Hip Abductor Strength, Gait Speed, and Pain in Early Postoperative Total Hip Arthroplasty: A Case Series

Hip abductor weakness is a common functional impairment in the early postoperative phase following total hip arthroplasty (THA), often contributing to gait disturbance, pain, and delayed recovery. Emerging evidence suggests that dysfunction of the superior gluteal nerve (SGN) may play a critical role in these impairments. However, clinical evidence for SGN-targeted rehabilitation remains limited. This case series aimed to explore the feasibility and preliminary effects of physiotherapy targeting the SGN on hip abductor strength, gait speed, and walking pain in the early postoperative period after THA. Eight patients (three males and five females; aged 60-85 years) who underwent primary unilateral THA via the anterolateral approach were included. On postoperative day 14, all participants received ultrasound-guided manual therapy targeting the SGN combined with visual feedback-based therapeutic exercises for the gluteus medius and minimus. Outcome measures assessed immediately before and after the intervention included hip abductor strength measured with a handheld dynamometer, maximum gait speed measured with the 10-m walk test, and walking pain assessed with the Numerical Rating Scale (NRS). Hip abductor strength improved from 3.4 ± 0.8 kgf to 5.3 ± 1.3 kgf. Gait speed increased from 0.55 ± 0.08 m/s to 0.73 ± 0.11 m/s. NRS pain scores for walking decreased from 3.6 ± 0.6 to 1.5 ± 0.7. Ultrasound assessment revealed consistent tenderness between the gluteus medius and minimus in all participants, supporting the rationale for SGN-focused intervention. This case series demonstrated that a single session of ultrasound-guided manual therapy combined with targeted therapeutic exercise focusing on SGN function led to immediate improvements in hip abductor strength, gait speed, and walking pain in patients during the early postoperative phase after THA. These preliminary findings suggest the potential clinical value of incorporating nerve-focused interventions into standard rehabilitation programs following THA.