Coming Soon to a Hip Near You: Osteotomy, Parts 1 and 2

Today was Hip Chick's two week follow up from her petrie cast removal.  Mommy and Daddy were tied in knots with anxiety about it, as we had a gut feeling regarding the news to come.  Our little hippie was in chipper spirits, however, and that helped settle our nerves somewhat.  Due to her bravery and physical cooperation at xray, Daddy let her snack on a box of Scottish Rite's buttery, freshly popped popcorn.  Popcorn and movies make great companions, so why not popcorn and xrays?

We quickly met the friendly faces of her medical team for her much-anticipated results.  Unfortunately, our gut feeling was correct:  More surgery will be needed- and a major one.  Hip Chick will require an open reduction, a salter pelvic osteotomy, and a femoral osteotomy.  

What does this mean?  In very simple terms, they will need to cut her pelvic bone to help reshape the hip socket.  They will need to cut the femoral head to angle it a little differently to meet her ajusted hip socket.  They may use pieces of bone that they remove from the femur to graft into the pelvis to help create a better socket shape.  She will require hardware (pins and screws) to hold these changes in place while the bone heals.  There is a good article regarding osteotomies on the International Hip Dysplasia Institute's website, link below:  

Child Treatment Methods: Osteotomy

After the osteotomies, she will spend two months in a spica cast.  After the casting, she will wear the Rhino Brace for a yet-to-be-determined period of time.  Six months after the osteotomies, she will return for another surgery to remove the hardware.  Her surgeon advised that it takes approximately six months for bone to heal, which is why the hardware cannot be removed before then.  The hardware cannot remain in her body for too long, however, or it will become encased her in bone as it grows and cause problems in the future.  The hardware removal is a more minor procedure in comparison and will not require casting.

And so it is.  Our hip dysplasia "sprint" of the past five months has now become a 5K.  Not exactly the G-rated, happy-go-lucky plotline we hoped for... but we can all agree that "Goonies never say die."

Below are our additional thoughts:

1. When will her open reduction and osteotomies be scheduled?  

The surgery will be scheduled for either late August or mid-September, depending on her surgeon's availability.  Regardless of the week it is scheduled, it will occur on a Monday.

2. What will need to occur to prepare for this surgery?

She has a pre-op appointment the Tuesday prior to surgery.  It will be a four to six hour process, to include an xray to check her femoral head's position.

3.  What are the risks of this surgery?

There is a very minor chance of hemorrhage.  There is the potential for avascular necrosis.  This means that circulation to the femoral head could be lost to some degree.  There is the potential for arthritic conditions later in life.

4. What are the risks if we do not complete this surgery?

While there is no certainty as to what her exact presentation of hip dysplasia could manifest later in life, the worst possibility includes the need for a full hip replacement in early adulthood.  

5. Why perform this surgery now?

Her surgeon advised that age is a factor in long-term success and the earlier, the better.  If we can correct her hip before she begins grade school, there is a good chance that her hip will show little to no sign of these pelvic surgeries in adulthood.  

6. Will this affect her ability to have children?

Her surgeon advised that she will still be able to have children.  I also polled my support group on the matter.  Of the responses I received, the women who had their hip dysplasia resolved in early childhood were able to have normal pregnancies and deliveries.  The ones who had surgery later in childhood had an elevated chance of cesarean.  The ones who never had their hip dysplasia corrected incurred debilitating pain during pregnancy and the pain never resolved for some.  

7. Will she continue to wear the Rhino Brace until surgery?

No.  The brace has been the source of much angst for Hip Chick and she appears to be in quite a bit of pain upon waking each morning.  She has also developed night terrors, which we suspect are related to the brace, her events of the past five months, or a combination thereof.  She had been screaming and shrieking at night with varying intervals, with questionable reasoning, and with limited response to us.  Last night, we pulled her out of bed and she shrieked for a bit of time without responding to our attempts to communicate or soothe her.  Inexplicably and suddenly, she fell back asleep on Daddy's chest.  

We discussed all of this with her surgeon today.  He advised that any improvements made prior to surgery from wearing the brace would be very minimal.  As she is obviously stressed and the household is not sleeping, she will be relieved from the brace until November or December of this year.

8. Will this development change our childcare situation?

We were eternally grateful and thankful to learn that her daycare will still partner with us regarding her care.  After her appointment today, I called to relay the news and ask her daycare to honestly consider whether they could still care for her in their classroom setting.  Tears welled in my eyes as we hung up and the teachers conferenced to decide.  I could not blame them if they said no- many institutions would.  But what would we do if they could not?  Who could take as good care of her as they do?  

Tears spilled again when they called back to indicate that, yes, we could still partner on Hip Chick's care.  It is one of the biggest gifts we could hope for. 

9. Will she require different equipment at home or school after surgery than before?

We will need to return the Hippo car seat that Scottish Rite leant us and exchange it for a harness.  She will soon move into the next class at daycare and this class may need a few new tools to help manage her care.  I am stopping by on Thursday afternoon for a quick conference to brainstorm.

10.  When will she walk again?

Her surgeon advised today that most children spend the same amount of time regaining mobility as they spent casted.  Hip Chick may not fully regain her ability to walk prior to her next surgery.  It would be prudent for us to anticipate she will take at least three months to regain mobility after her next casting phase.  It is our hope and dream to see her walk by her third birthday.