What is Hip Tenotomy?
Hip tenotomy is a surgical procedure that involves cutting or releasing a tendon in or around the hip joint. It is often performed to alleviate tension, improve range of motion, or address pain caused by conditions affecting the tendons or muscles in the hip region. The procedure can be done as an open surgery or minimally invasive surgery, depending on the specific condition and approach.
Indications for Hip Tenotomy
Hip tenotomy is typically considered in the following scenarios:
- Hip Contractures: Tight or shortened tendons that restrict movement, often seen in conditions like cerebral palsy or after prolonged immobility.
- Tendinopathies: Chronic tendon conditions such as iliopsoas tendinitis or adductor tendinopathy that do not respond to conservative treatments.
- Spasticity Management: In neurological disorders like spastic diplegia, where muscle overactivity leads to joint stiffness.
- Pain Relief: Severe pain caused by tendon involvement in degenerative or inflammatory conditions.
- Surgical Adjunct: As part of other hip procedures like total hip arthroplasty or hip impingement surgery.
Procedure for Hip Tenotomy
In general, a hip tenotomy surgery may involve the following steps:
- The patient is placed under general anesthesia (asleep) or regional anesthesia (numbing the lower body).
- The patient is positioned to give the surgeon optimal access to the hip area, often lying on the back or side.
- The surgical site is cleaned and sterilized to reduce the risk of infection.
- The physician may employ any of the following approaches for surgical access:
- Percutaneous Approach: A minimally invasive approach in which a small incision (a few millimeters) is made near the hip joint.
- Open Approach: For more complex cases, a larger incision is made to provide better visualization of the structures.
- Arthroscopic Approach: Small incisions (portals) are created for inserting an arthroscope (a camera) and surgical instruments. The arthroscope provides a magnified view of the tendon and surrounding tissues.
- The surgeon carefully identifies the specific tendon causing the problem. Common tendons addressed include:
- Iliopsoas tendon: For conditions like snapping hip syndrome or contractures.
- Adductor tendons: Often released in cases of spasticity or stiffness.
- The surgeon uses a scalpel or specialized surgical tools to:
- Partially cut the tendon (partial tenotomy) to reduce tension while preserving some function.
- Completely cut the tendon (complete tenotomy) in cases of severe contracture or when the tendon’s function is no longer needed.
- The release may be performed in conjunction with other procedures, such as hip joint repositioning or soft tissue adjustments.
- Finally, the incision (s) may be closed using small sutures, staples, or adhesive strips.
Postoperative Care and Recovery
After a hip tenotomy procedure, the patient is monitored in a recovery area until the effects of anesthesia wear off. Medications like NSAIDs or prescribed analgesics are given to control pain. The patient may initially require crutches or a walker to avoid putting stress on the hip. Physical therapy typically begins soon after surgery to restore range of motion, improve strength, and promote healing. The duration of rehabilitation depends on the extent of the procedure and the underlying condition, with most patients gradually resuming normal activities over several weeks to months. Follow-up appointments are scheduled to monitor progress, ensure proper healing, and address any concerns.
Risks and Complications
Risks and complications associated with hip tenotomy include:
- Infection
- Bleeding or hematoma
- Scar tissue formation
- Persistent pain or stiffness
- Nerve or blood vessel injury
- Weakness or reduced function in the released tendon
