PMC9637861_01
(A) Preoperative plain radiograph, (B) T2 coronal, (C) T1 horizontal, and (D) T1 coronal. View of MRI showing the calcification around the tip of the right greater trochanter (marked with arrows).
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F1
Plain radiography showed a 1.0 x 2.0 cm diameter calcific deposit superomedial to the greater trochanter; this corresponded to the tendinous insertion of the gluteus medius (Figure 1A).
(A) The patient was placed supine on a traction table; an anterolateral approach (ALA) was approximately 1 cm superior and anterior to the anterior edge of the greater trochanter; an anteromedial approach (AMA) was performed at the junction of a sagittal line drawn from the anterior superior iliac spine and a horizontal line drawn from ALA (B) surgical instruments used in hip endoscopic surgery.
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F2
Next, an anteromedial approach (AMA) was established under endoscopy surveillance (Figure 2A). A 30  hip scope was inserted to visualize the gluteus medius tendon and the tip of the greater trochanter (Figure 2B).
(A) Endoscopic view of a calcified deposit, (B) Endoscopic view showing a soft white toothpaste-like material in the deposit, (C) postoperative plain radiograph view showing complete removal of the calcific deposit, and (D) hydroxyapatite crystals in the specimen confirmed by a pathologic examination (marked with arrows).
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F3
A soft white toothpaste-like material was observed when the degenerated gluteus medius tendon was debrided (Figure 3A,B). Postoperative radiography revealed that no calcification remained (Figure 3C). The specimen was sent for pathologic examination, which confirmed that the calcified tendon consisted of hydroxyapatite crystals and proliferative tendon fibrous tissue (Figure 3D).