Name of the Procedure:

Tenotomy, abductors, and/or extensor(s) of hip, open (separate procedure)

Summary

An open tenotomy of the hip involves surgically cutting one or more of the tendons that control the movement of the hip abductors or extensors. This procedure is performed to address deformities or tightness in the hip muscles, improving range of motion and function.

Purpose

The medical condition it addresses includes muscle contractures or spasticity in the hip, often due to conditions such as cerebral palsy or other neuromuscular disorders. The goals are to alleviate pain, improve mobility, and enhance the patient's overall quality of life.

Indications

• Muscle spasticity or contractures in the hip
• Cerebral palsy or similar neuromuscular disorders
• Involuntary muscle contractions causing limited hip movement
• Failure of conservative treatments like physical therapy or medications

Preparation

• Patients may need to fast for 8-12 hours prior to the surgery.
• Stopping certain medications as advised by the surgeon.
• Undergoing pre-operative diagnostic tests like X-rays or MRI.
• Pre-surgical assessment and clearance, especially for patients with underlying health conditions.

Procedure Description

1. The patient is given either general anesthesia or regional anesthesia.
2. An incision is made in the skin over the hip area.
3. The surgeon identifies and isolates the tendon(s) to be cut.
4. The selected tendons (abductor or extensor) are carefully cut to relieve tension.
5. The incision is closed with sutures, and a sterile dressing is applied.
6. Sometimes, additional motion-limiting devices or braces are utilized post-procedure.

Duration

The procedure typically takes between 1 to 2 hours, depending on the complexity and the number of tendons involved.

Setting

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

Personnel

The procedure involves a team of healthcare professionals, including:

• Orthopedic surgeon
• Surgical nurses
• Anesthesiologist or nurse anesthetist
• Surgical technologist

Risks and Complications

• Infection
• Bleeding or hematoma
• Nerve damage
• Pain or discomfort at the surgical site
• Risk of recurrence of contracture
• Complications from anesthesia

Benefits

• Improved range of motion in the hip
• Reduction of pain associated with tight or spastic muscles
• Enhanced mobility and better quality of life
• Some benefits may be realized immediately, while others could take weeks to months as the patient undergoes rehabilitation.

Recovery

• Post-procedure care includes pain management with medications.
• Instructions for wound care to prevent infection.
• Physical therapy may be required to optimize recovery.
• The typical recovery time is several weeks to months, but it varies from patient to patient.
• Restrictions on weight-bearing activities and a gradual return to normal activities.

Alternatives

• Conservative treatments like physical therapy, stretches, and strengthening exercises.
• Botulinum toxin (Botox) injections to temporarily relax muscles.
• Medication to manage spasticity.
• Pros and cons: Surgical intervention is often only recommended when other treatments have been ineffective.

Patient Experience

• Patients may feel soreness, stiffness, or pain immediately after the surgery, which can be managed with pain medications.
• During recovery, physical therapy may cause some discomfort but is essential for regaining strength and mobility.
• Most patients report significant improvements in movement and reduction in pain after full recovery, contributing to a better overall quality of life.