Name of the Procedure:

Tenotomy, Adductor of Hip, Open Common names: Adductor Tenotomy, Open Hip Adductor Release

Summary

An open tenotomy of the adductor muscle of the hip is a surgical procedure that involves cutting the adductor muscles near the hip to relieve muscle tightness or contracture. This is performed through a small incision in the skin.

Purpose

This procedure addresses conditions of muscle tightness or contracture in the hip, often due to cerebral palsy, spasticity disorders, or hip dysplasia. The goal is to improve movement, reduce pain, and enhance overall function of the hip.

Indications

• Persistent spasticity or contracture of the hip adductor muscles
• Limited range of motion in the hip
• Pain due to muscle tightness
• Difficulty in sitting, standing, or walking due to hip muscle contracture

Preparation

• Fasting for at least 8 hours before the procedure
• Adjustments to medications, especially blood thinners
• Pre-operative physical examination
• Imaging studies like X-rays or MRI to evaluate the hip

Procedure Description

1. The patient is positioned on the operating table, and general or spinal anesthesia is administered.
2. The surgeon makes a small incision near the hip area to access the adductor muscles.
3. The adductor tendons are identified and selectively cut to release tension.
4. The incision is closed with sutures, and a sterile dressing is applied.

Duration

The procedure typically takes about 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
• Scrub technician

Risks and Complications

• Infection at the incision site
• Bleeding or hematoma formation
• Damage to surrounding nerves or tissues
• Temporary or permanent weakness in the hip muscles
• Scarring and delayed wound healing

Benefits

• Alleviation of muscle tightness
• Improved range of motion and ease of movement
• Reduction in pain and discomfort
• Enhanced ability to perform daily activities

Recovery

• Post-operative pain management with prescribed medications
• Physical therapy to restore mobility and strength
• Instructions to avoid weight-bearing activities on the operated leg for a specified period
• Follow-up appointments with the surgeon to monitor healing
• Full recovery typically expected within 6-12 weeks

Alternatives

• Physical therapy and stretching exercises
• Pharmacological treatment with muscle relaxants
• Botulinum toxin (Botox) injections to reduce spasticity
• Less invasive procedures or ultrasound-guided tenotomy

Patient Experience

Patients may experience pain and discomfort immediately after the surgery, which is managed with medications. Swelling and bruising are common but typically resolve within a few weeks. Gradual improvements in range of motion and a reduction in pain are expected with adherence to post-operative care and physical therapy.