MRI for the detection of hip abductor tendon tears in symptomatic patients with total hip arthroplasty following a lateral surgical approach

OBJECTIVES: To evaluate the diagnostic accuracy of MRI for detecting clinically suspected hip abductor tendon tears in symptomatic patients after total hip arthroplasty and to evaluate the association between specific MRI features and surgically confirmed tears. MATERIALS AND METHODS: This retrospective study included 36 patients with total hip arthroplasty who underwent revision surgery for a suspected abductor tendon tear and had preoperative MRI available. Intraoperative findings served as the reference standard for the presence of partial or full-thickness tears of the gluteus medius (Gmed) and gluteus minimus (Gmin) tendons. Two readers evaluated MRI for tendon integrity (intact, partial-thickness, or full-thickness tear). Associations between tendon defects, peritrochanteric fluid, tendon signal abnormalities, and Gmed/Gmin Goutallier grades with surgical findings were analyzed using regression models to calculate odds ratios (ORs). RESULTS: For detection of abductor tendon tears, Reader 1 achieved sensitivities of 0.86-1.00, specificities of 0.93-1.00, and accuracies of 0.92-0.97, while Reader 2 achieved sensitivities of 0.86-1.00, specificities of 0.90-1.00, and accuracies of 0.89-1.00. Imaging findings associated with partial- or full-thickness tears included tendon defects (Gmed: OR = 35.5, p = 0.007; Gmin: OR = 30.0, p < 0.001), peritrochanteric fluid (Gmed: OR = 64.2, p = 0.01; Gmin: OR = 74.9, p = 0.01), and higher Goutallier grade (Gmed: OR = 2.34, p = 0.03; Gmin: OR = 4.75, p = 0.02). CONCLUSION: MRI demonstrated high diagnostic accuracy for detecting surgically confirmed hip abductor tendon tears in this selected symptomatic surgical cohort following total hip arthroplasty. Tendon defects and peritrochanteric fluid were significantly associated with partial- or full-thickness tendon tears. KEY POINTS: Question There is limited data on the diagnostic accuracy of MRI for hip abductor tendon tear detection following total hip arthroplasty. Findings MRI demonstrated high diagnostic accuracy for detecting surgically confirmed abductor tendon tears in symptomatic patients with total hip arthroplasty. Clinical relevance In symptomatic patients with clinical suspicion of an abductor tendon tear undergoing evaluation for revision surgery, MRI can be used to noninvasively assess the integrity of the abductor tendons after total hip arthroplasty.