Name of the Procedure:

Tenotomy, adductor of hip, percutaneous (separate procedure)

• Common name: Adductor Tenotomy
• Medical term: Percutaneous Adductor Tenotomy

Summary

This procedure involves cutting the adductor muscles of the hip through a small incision. It's a minimally invasive technique often used to relieve tightness or contractures in the hip area.

Purpose

The procedure is performed to address hip adductor muscle tightness or contracture, which can cause pain, restricted movement, or difficulty with walking. The goal is to release the tight muscle, thus improving mobility and reducing pain.

Indications

• Chronic hip pain due to muscle tightness
• Mobility limitations caused by tightened adductor muscles
• Specific conditions like cerebral palsy, where muscle contractures are common
• Ineffectiveness of other treatments like physical therapy or medications

Preparation

• Fasting for at least 6-8 hours before the procedure if general anesthesia is used.
• Discontinuing certain medications like blood thinners, as advised by the physician.
• Pre-procedure assessment, including physical examination and imaging studies like ultrasound or MRI.

Procedure Description

1. The patient is positioned to allow access to the hip area.
2. The skin over the hip is cleaned with an antiseptic solution.
3. Local or general anesthesia is administered to minimize discomfort.
4. A small incision is made near the hip to insert a thin needle or surgical instrument.
5. Using ultrasound guidance, the adductor muscle is identified.
6. The targeted muscle is carefully cut through the needle or instrument.
7. The incision is closed with sutures or adhesive strips.

Duration

The procedure typically takes about 30 minutes to 1 hour.

Setting

• Performed in a hospital, outpatient clinic, or a specialized surgical center.

Personnel

• Orthopedic surgeon or specialized surgical doctor
• Anesthesiologist or nurse anesthetist
• Surgical nurse

Risks and Complications

• Common risks: Infection, bleeding, bruising
• Rare risks: Nerve damage, incomplete release of the muscle, adverse reactions to anesthesia
• Management: Anticipated complications are managed with antibiotics, pain medications, and follow-up visits.

Benefits

• Improved hip mobility and range of motion
• Reduced pain and discomfort in the hip region
• Enhanced ability to perform daily activities and physical therapy exercises

Recovery

• Post-procedure care includes resting the affected leg and ice application to reduce swelling.
• Pain management with prescribed medications.
• Gradual return to normal activities with possible physical therapy.
• Recovery time typically ranges from a few days to several weeks, with follow-up appointments to monitor progress.

Alternatives

• Non-surgical options like intensive physical therapy or botulinum toxin injections.
• Pros: Non-invasive, no surgical risks
• Cons: May not be as effective for severe contractures, longer duration to see results

Patient Experience

• During the procedure: Minimal discomfort due to anesthesia; patient might feel pressure but not pain.
• After the procedure: Mild to moderate pain which can be managed with medications, possible temporary use of crutches or a walker, and involvement in rehabilitation exercises.

Overall, percutaneous adductor tenotomy is a safe and effective procedure for those suffering from severe hip adductor contractures, leading to improved quality of life and physical function.