EP8.95 Hip Abductor Pathology and Postoperative Outcomes: Clinical Validation of the Wisconsin Hip Abductor (WHAb) Classification System

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ID: 331076
2026
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Abstract
Abstract Background Tears of the gluteus medius (GMed) and gluteus minimus (GMin) are a recognized source of lateral hip pain, gait dysfunction, and functional impairment. Chronic abductor insufficiency can lead to fatty infiltration (FI) and muscle atrophy, which may limit recovery after surgical repair. Existing FI grading systems are adapted from shoulder pathology and may inadequately characterize hip-specific muscle degeneration. The Wisconsin Hip Abductor (WHAb) classification system was developed as a hip-specific MRI-based method incorporating abductor muscle thickness, fat content, and fat localization to assess abductor muscle quality. Purpose To evaluate whether preoperative hip abductor muscle quality, quantified using the WHAb classification system, is associated with postoperative patient-reported outcomes (PROs) following abductor tendon repair. Methods Patients undergoing primary GMed and/or GMin repair between 2017 and 2025 were retrospectively reviewed. Inclusion required preoperative axial T1-weighted MRI suitable for WHAb grading and complete PRO data through ≥12 months. GMed and GMin were graded using the WHAb system and averaged to generate a composite score, dichotomized as low-grade (0–2) or high-grade (3–4). PROs were collected pre- and postoperatively using validated instruments. Between-group differences were assessed using two-sample t tests. Results Eleven patients met inclusion criteria. All demonstrated preoperative FI, and the WHAb system differentiated muscle quality by incorporating severity, distribution, and localization of FI in addition to muscle thickness. Anterior or combined fat localization was most common, highlighting heterogeneity not captured by FI alone. At ≥12 months, patients with low WHAb scores showed greater improvement across all PROs compared with those with high WHAb scores. A statistically significant difference was observed for the Hip Outcome Score–Sports subscale (p=0.037), with other outcomes showing similar but nonsignificant trends. Conclusion The WHAb classification system demonstrated clinical utility in stratifying hip abductor muscle quality and predicting postoperative functional improvement. Although FI was present in all patients, WHAb grading identified differences in severity and distribution associated with postoperative outcomes, demonstrating improved stratification compared with binary or shoulder-derived grading systems. WHAb may provide a more clinically meaningful assessment of abductor pathology to guide preoperative counseling and surgical decision-making.
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Authors Madeline Tabor, Elizabeth Collinson, David Chen, Samuel J. Mosiman, Haley Smith, Donna G. Blankenbaker, Andrea M. Spiker
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Journal Journal of hip preservation surgery
Year 2026
DOI
10.1093/jhps/hnag043.474
URL
https://doi.org/10.1093/jhps/hnag043.474
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