SURGICAL PROTOCOL: HIP OSTEOTOMY
It has been recommended that your child have an osteotomy about the hip. This may involve cutting the femur, (lower bone) or it may involve cutting the pelvis (upper bone) or cutting both bones in an effort to put the ball back into the socket.
Surgically the operation is designed to locate the hip (put the ball back in the socket) and to be sure that the socket is deep enough to keep the hip located. After this type of surgery, there may be some shortening of the operated leg.
An osteotomy means – cutting the bone. Either the femur or the pelvis or both, may need to be cut to accomplish the goals. The procedure takes a minimum of two and possibly as long as five hours to complete. After the bone or bones have been cut, they are fixed with a metallic implant. This may be a screw, pin or plate. In addition, the child will be placed in a spica or body cast, to prevent a great deal of motion from loosening the fixation device.
Specific care of the body cast will be reviewed by the nurses during the post operative period. When your child goes home he or she can be managed in a chair, bed, wagon or enlarged skateboard on a day to day basis. Cast care is important to minimize rashes and other areas of skin breakdown. The child’s appetite may be altered because of the presence of the body cast. The average period of casting is six weeks. At this time the child is usually given an general anesthetic, on an in and out basis, to remove the cast and occasionally remove some of the pins which have been used to fix the cut bones.
After removal of the cast and several weeks of skin care, the child can be returned to physical therapy. The therapist may move, stretch and work on strengthening any joint, which is not immobilized. Standing and walking if applicable can be started on a graded basis at approximately 8 to 10 weeks. Usually, it is necessary to use crutches or a walker in the initial stages of ambulation. Generally the hip will be stiff for three to four months after the surgery therefore, it will be painful if pushed or pulled to a great extent.
Operative time is three to five hours. Hospital stay, is three to five days. Casting time is six to eight weeks with cast removal and possible pin removal under anesthesia, on an in and out basis. Physical Therapy begins at eight to then weeks from surgery.