Functional outcomes following surgery for spastic hip adductor muscles in ambulatory and non-ambulatory adults

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Brun, Daphnée | Hamel, Olivier | Montané, Emmeline | Scandella, Marino | Castel-Lacanal, Evelyne | de Boissezon, Xavier | Philippe, Marque | Gasq, David | Cormier, Camille

Edité par CCSD ; Foundation for Rehabilitation Information -

International audience. Objective: To evaluate functional outcomes of surgery of spastic hip adductor muscles (obturator neurotomy with or without adductor longus tenotomy) in ambulatory and non-ambulatory patients, using preoperatively defined personalized goals. Design: Retrospective observational descriptive study. Patients: Twenty-three patients with adductor spasticity who underwent obturator neurotomy between May 2016 and May 2021 at the Clinique des Cèdres, Cornebarrieu, France, were included. Methods: Postoperative functional results were evaluated in accordance with the Goal Attainment Scaling method. Patients were considered "responders" if their score was ≥ 0. Secondary outcomes included spasticity, strength, hip range of motion and change in ambulatory capacity. When data were available, a comparison of pre-and postoperative 3-dimensional instrumented gait analysis was also performed. Results: Among the 23 patients only 3 were nonwalkers. Seventeen/22 patients achieved their main goal and 14/23 patients achieved all their goals. Results were broadly similar for both walking goals (inter-knee contact, inter-feet contact, fluidity, walking perimeter, toe drag) and non-walking goals (intimacy, transfer, pain, posture, dressing). Conclusion: Surgery of spastic hip adductor muscles results in functional improvement in ambulation, hygiene, dressing and posture and can be offered to patients with troublesome adductor overactivity. The use of a motor nerve block is recommended to define relevant goals before the surgery.

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