A Salter Osteotomy for Developmental Dysplasia of the Hip

Where to start! What a week. Erin’s hip journey has been well documented from the start and I knew the pelvic salter osteotomy operation would be tough going on her little body and on my emotions but I never expected to watch her suffer so much.  To see her become weaker and weaker.

The operation

A Salter Osteotomy is a type of pelvic osteotomy used to treat developmental dysplasia of the hip (DDH). You can read about the different operations on Cast Life.

A salter osteotomy is done when the hip socket does not sit on top of the ball of the femur.  For Erin, the operation lasted an agonising four hours.  It is invasive surgery with an expected hospital stay of two to three nights, providing everything goes to plan.

The operation itself is illustrated in the diagram below which comes from the international hip dysplasia institute.

The first image shows what Erin’s socket is similar to, and the second image shows where the socket has been built up, rotated and pinned. Erin has two wires that are holding the new hip socket together whilst also being in spica. The pins will come out under another general anaesthetic in six weeks time. Because Erin has already had a closed reduction and 18 weeks in spica she only needs six weeks this time.  Bone heals faster.

The reality of the Salter Osteotomy

The first two days were textbook and I was hopeful of an early discharge however things were soon out of my control. The anaesthetist had already told us that during the surgery there had been a problem with her breathing, he explained that she had either an asthma attack or was brewing an infection.  He had given her some extra antibiotics due to the length of surgery and how she had been. 

Thankfully I have absolute faith in the anaesthetist and he has looked after Erin each time she has had a general and he will be looking after her next time too. He is the person that has given me the most information throughout the whole spica journey.  On Wednesday Erin spiked a temperature and it was decided to stay in an extra night just to see how it goes. Her eardrum had perforated earlier in the day.

By the evening she was unwell and we both tried to settle into a fitful rest. She was having spasms that were uncomfortable to watch and she started refusing her medication and generally not talking and responding too much and lying very still.

At about 11pm her temp was taken again and it had continued to rise. Her heart rate was also very high by this point and the nurse called for the doctor. The doctor could hear chest crackles and diagnosed a chest infection, there was talk of chest Xrays and it was quickly decided that Erin needed extra fluids via a drip, IV antibiotics and blood tests.

As Erin was wheeled out to the treatment room I started to panic. It always seems even worse during the night, when the hospital is relatively quiet and you are all alone.

The rest of the night passed in a blur with Erin being observed every 30 mins.  Thursday was much the same with meds now being given intravenously and rectually.  It was the most distressing 24 hours of my life.  However, come Thursday evening her temp had returned to normal and she slept well all night.

Erin astounded me when she woke at 7.30 Friday morning, looked at me said ” I’m better now mummy, breakfast?”

She ate for the first time since Tuesday.  As she continued to perk up through the morning I started asking if we could get home and thankfully after seeing an ENT doctor, he agreed.  However, it was decided that Erin needs to be under the care of ENT in addition to orthopaedics (she collects doctors like her brother collects football cards!).

The pain from the salters is pretty much as I had read and expected it to be.  As soon as the pain killers begin to wear off Erin starts telling me it hurts.  I am thankful that she is now of an age that she can tell me this.  She is very wary to move and doesn’t even want to sit on anyone’s lap.  I can see the top of the cut by looking down at the cast.  She has huge bruises and I am expecting quite a big scar that runs from above and below the hip.

At the moment I cannot imagine her crawling around in this cast, yet I know that in a couple of weeks she will!

I continue to hope that this will be the final part of our hip journey apart from the regular X-rays she will have throughout her childhood.  We hope that after removal we won’t need any more surgery.

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