27036 Capsulectomy or capsulotomy, hip, with or without excision of heterotopic bone, with release of hip flexor muscles (ie, gluteus medius, gluteus minimus, tensor fascia latae, rectus femoris, sartorius, iliopsoas)

Name of the Procedure:

Capsulectomy or Capsulotomy, Hip
Alternate Terms: Hip Capsulectomy, Hip Capsulotomy

Summary

A capsulectomy or capsulotomy of the hip is a surgical procedure that involves removing or cutting the capsule of the hip joint. This procedure may also include the excision of abnormal bone growths (heterotopic bone) and the release of hip flexor muscles such as the gluteus medius, gluteus minimus, tensor fascia latae, rectus femoris, sartorius, and iliopsoas.

Purpose

This procedure addresses pain, stiffness, and movement limitations caused by conditions like hip impingement, post-traumatic bone growth, or hip flexor muscle contracture. The goal is to improve hip joint function, reduce pain, and enhance the patient's quality of life.

Indications

• Persistent hip pain unresponsive to conservative treatments
• Limited range of motion in the hip
• Hip impingement syndrome
• Presence of heterotopic bone growth around the hip joint
• Muscle contractures affecting the hip flexors

Preparation

• Patients may be required to fast for several hours before the surgery.
• Adjustments or discontinuation of certain medications, as advised by the doctor.
• Diagnostic imaging tests like X-rays or MRIs to assess the hip joint.
• Pre-operative evaluation including blood tests and a physical examination.

Procedure Description

The procedure is performed as follows:

1. The patient is placed under general anesthesia.
2. A surgical incision is made near the hip joint.
3. The hip capsule is either partially or completely removed (capsulectomy) or incised (capsulotomy).
4. Any heterotopic bone growth is excised.
5. Tight hip flexor muscles are released or lengthened to improve joint movement.
6. The incision is closed with sutures or staples, and a sterile dressing is applied.

The procedure may utilize specialized surgical instruments and imaging techniques for precision.

Duration

The procedure typically takes 1-2 hours, depending on the complexity.

Setting

The procedure is usually performed in a hospital operating room or a specialized surgical center.

Personnel

• Orthopedic surgeon
• Anesthesiologist
• Surgical nurse
• Surgical technologist

Risks and Complications

Common risks:

• Infection
• Bleeding
• Blood clots

Rare complications:

• Nerve damage
• Poor wound healing
• Recurrence of heterotopic bone growth
• Persistent pain or stiffness

Benefits

• Relief from hip pain
• Improved range of motion and joint function
• Enhanced ability to perform daily activities
• Patients may start noticing improvements a few weeks after surgery.

Recovery

• Post-operative care includes pain management, physical therapy, and wound care.
• Patients should avoid strenuous activities until cleared by their doctor.
• Full recovery may take several weeks to months, with regular follow-up appointments to monitor progress.

Alternatives

• Physical therapy and exercise programs
• Medications, including anti-inflammatories and pain relievers
• Minimally invasive treatments like corticosteroid injections
• Hip arthroscopy as a less invasive surgical option

Patient Experience

During the procedure, the patient will be under general anesthesia and will not feel any pain. Post-surgery, patients may experience pain and discomfort at the incision site, managed with pain medications. Physical therapy will likely be necessary to regain strength and mobility, with gradual improvement over time.