AbstractIntroduction: Trochanteric pain frequently manifests as a post-hip arthroplasty complication, attributed to pelvic trochanteric muscle injuries, thereby impeding routine activities. This video technique aims to illustrate an inventive strategy employing Hip Abductor Reconstruction with an Open Double Row technique, concomitant with Partial Tensor Fasciae Latae transfer, as a therapeutic intervention for Severe Trendelemburg following Total Hip Replacement, with the objective of augmenting functional recuperation.Materials and Methods: A 47-year-old female, who had previously undergone right total hip replacement via a modified Hardinge lateral approach two years prior, presented with acute trochanteric pain and significant activity restrictions. Magnetic Resonance Imaging (MRI) delineated a complete tear with partial retraction of the gluteus medius and minimus muscles, classified as Goutallier Grade 3. Physical examination revealed a pronounced Trendelenburg gait, with positive Ossendorf and Lequesne tests indicating strength deficits and pain. The video illustrates the surgical anatomy of gluteal tendon insertion, injury identification, and the procedural technique comprising double-row reconstruction of the gluteal tendon with augmentation, concomitant with partial transfer of the tensor fascia lata muscle to the greater trochanter.Results: At the one-year follow-up, the patient reported sporadic trochanteric pain and ambulated without assistance. Upon physical examination, hip abduction against gravity and resistance from the operator was achievable, with negative Ossendorf and Lequesne test outcomes. The patient exhibited enhancements in modified Harris Hip Score (mHHS), Hip Outcome Score (HOS), and International Hip Outcome Tool (iHOT) scores from preoperative assessment to 6-month and one-year postoperative evaluations, with scores escalating from 50 to 67 and 94; 40 to 70 and 98; 30 to 60 and 90, respectively.Conclusion: Our technique showcased promising functional recovery at the one-year follow-up, albeit this study being a single case. Large-scale, heterogeneous studies are imperative for scrutinizing its efficacy over the medium-to long-term. Despite this constraint, this approach epitomizes a pioneering advancement in managing trochanteric pain with severe Trendelemburg subsequent to total hip arthroplasty.