Hip Dysplasia, DDH, Clicky hips call it what you wish but this condition is frightening and life-changing for children and their families.
There’s no such thing as a severe hip dislocation if a hip is out it is out. To my mind, it is that simple because treatment is the same no matter what degree of the angle we are talking about. I keep seeing posts from concerned parents saying that they have been told that ‘their case’ is severe and it seems to be really scaring people. This post will explain some of the treatment terms. I am not medically qualified and this is my opinion backed up by my own reading and understanding. DDH was once referred to as clicky hips, however, this does not acknowledge the condition or the seriousness of it.
Unfortunately, the bottom line is if your child has been late diagnosed then the treatment is going to take time and the end results will not be as good as if they had been fitted with a Pavlik harness within the first few weeks of their life. The statistics speak for themselves and 95% of those in a pavlik harness will have a successful outcome after clicky hips have been diagnosed. For another 5% and those of our children who were late diagnosed (22 months here) spica casting is the treatment.
What do all the medical terms mean?
Spica Cast– put simply a spica cast is the term used when a child is in a plaster cast from their belly to ankles. Some sureons start above the belly button, others at the belly button. The cast can go down both legs all the way. Or it could be a full leg on the affected hip and a shorter length on a unaffected hip side. Some surgeons cover the ankle and finish at the toes, others stop at the ankles. A bar is often placed from knee to knee. This makes the spica stronger and is important for children likely to move as an a frame is stronger. Never lift or carry you child by the bar it is not a handle although it is very good for balancing an iPad on!
A closed reduction – this refers to the child being under a general anesthetic and the surgeon will manipulate the femur so that the ball and socket are aligned. For this to happen the surgeon may need to release a tight tendon. This is known as a tenotomy and involves a small incision. The child is then cast in a spica cast for a period of time. Twelve weeks is standard practise by many surgeons but don’t be alarmed if yours is much longer. It is down to the surgeon, We did 18 weeks after a closed reduction. The way you care for your child doesn’t change whether it is 12 weeks or 24. It is often not a sign of how severe the dislocation was surgeons just have their own preferences.
An open reduction – this refers to surgery that is undertaken to bring the head of the femur (the ball) into the acetabulum (hip socket). Surgery is performed through a cut in the groin. The careful release of tight tendons and ligaments is performed to ensure the socket is clear. The joint capsule is then repaired. The child is then placed in a spica cast for anything upwards of twelve weeks, depending on your surgeon’s preference.
Now this is where I get a bit uppity – a closed reduction will often be tried before an open. It is less invasive and there are fewer risks of infection etc but the post-operation treatment and care is the same, this is why I personally say try not to get het about how severe the dislocation / subluxation is. Treatment now follows the same path. A child that has had an open will need more pain relief in the first few days but from here on in the journey is the same. A closed reduction does not mean your child’s dislocation was less, it simply means manipulation got it to where it needed to be.
An osteotomy refers to the bone being cut. The two types used in DDH are a pelvic osteotomy and a femoral osteotomy. Sometimes both procedures are carried out together.
A pelvic osteotomy reshapes the socket bone and there are several different types carried out. A salters is commonly used in the UK followed by a Pemberton. Our story of a salters is here. Children are normally casted in spica for six weeks after this surgery. This operation is used after less invasive treatments, however for children late diagnosed they may go straight for an osteotomy without having tried an open or closed procedure. One or two pins are often used to hold the new bone grafts in place during healing and will be removed when the spica comes off or at a later date.
A femerol osteotomy is used to realign the femur, it is split surgically just below the femoral neck and rotated to the best position. The femoral osteotomy is then secured in the correct position with a metal plate and screws or metal pins. The child is then in a spica cast for up to eight weeks. The plate and pins will be removed at a later date.
Recovery for osteotomies are dependant on the child but you can expect to stay in hospital for between 3-5 nights depending on how they are managing their pain and whether they recover quickly from the anesthetic.
I hope this glossary of key terms help you to understand the types of treatment for DDh. Are there any other words which you don’t understand or you think that should be included?
Other related posts:
3. Erin’s story
This picture is when Erin and I were on the lunchtime news talking DDH and swaddling.