Advice for parents about osteotomy of the hip

Advice for parents about osteotomy of the hip

What is an osteotomy and why does my child/young person need this operation? An osteotomy is an operation performed to place and hold the hip in an improved position in the hip socket. The leg bone (femur) or the pelvic bone is cut and twisted into position, then held in place using a metal plate and/or screws. If your child is under 5 years old, a hip spica cast will be fitted from the waist to the knee or ankle, to keep the hip in the correct position for 6-12 weeks. For children 5 years of age and over - a cast will not be fitted. Your child/young person will have any metal plates and/or screws removed 6-18 months after the operation. This operation is usually performed when other treatments for your child s/young person s dislocated hip have been unsuccessful. It is also performed for a variety of other conditions such as: Perthes disease After injury or infection Cerebral palsy What are the benefits of my child/young person having an osteotomy? This surgery will enable the hip to sit correctly in the hip socket, encouraging normal development of both the hip and socket. This will encourage your child s/young person s normal walking gait and will reduce the chances of your child/young person having a permanent limp in the future and for developing arthritis in early adult life.

What are the risks, consequences and alternatives associated with my child/young person having an osteotomy? Most operations are straightforward; however as with any surgical procedure there is a small chance of side-effects or complications: There is a small risk of infection. Although usually successful, the operation does not guarantee normal development of the hip, and more surgery may be required at an older age. There is a small risk of the blood supply to the hip being restricted, which can lead to increased deformity of the bearing surface. When the operation is carried out for dislocation there is a 10-15% chance of the hip re-dislocating at the same point later. If you are concerned about these risks, or have any further queries, please speak to your child s/young person s consultant. Your child s/young person s consultant has recommended this procedure as being the best option. However, the alternatives to this procedure will depend on your child s/young person s condition and the reason for this operation. If you would like more information, please speak to your child s/ young person s consultant or one of the nurses caring for your child/young person. There is also the option of your child/young person not receiving any treatment at all. The consequence of your child/young person not receiving any treatment is that their condition will continue or may deteriorate. If you would like more information please speak to your child s/young person s consultant or one of the nurses caring for your child/young person.

Getting ready for the operation You will be informed of your child s/young person s pre-assessment appointment and your child s/young person s date of surgery usually 2-3 weeks before the date of admission. It is necessary to attend a pre-assessment appointment, (which is usually a week before the date of admission). This visit is necessary to ensure that your child/young person is prepared for theatre. Here you will be given information regarding the operation and admission. You will also have the opportunity to ask any questions whilst familiarising yourself and your child/young person with the hospital. Verbal and written fasting instructions will be given to you. You will be asked to sign a form giving consent to your child s/ young person s surgery at the outpatient appointment and to confirm consent on the day of the operation. The surgeon will give you opportunity at this time to ask any further questions. If your child/young person feels unwell a few days before the operation, please telephone the Sunflower Ward (details are at the end of this booklet). Usually your child/young person will need to stay in hospital for 3-5 days and you are welcome to stay too. Please discuss this with the nursing staff on the Sunflower Ward on the day of admission.

What sort of anaesthetic will my child/young person be given? When your child/young person comes in for their operation a consultant anaesthetist (who is a qualified medical doctor with specific specialist training in anaesthesia) will give the anaesthetic. The anaesthetist will review the general health of your child/young person and discuss with you and your child/young person the anaesthetic care plan. If your child/young person has any specific problems please inform the anaesthetist at this stage. If you have any questions or concerns, please raise them with the anaesthetist. Your child/young person will be given a local anaesthetic cream on the back of their hands in order to reduce much of the discomfort caused by the anaesthetic injection. Sometimes your child/young person may be sent off to sleep by encouraging him/her to breathe a mixture of gases instead of an injection. It usually takes a little longer but the breathing method is just as safe and very useful, particularly if your child/young person is very agitated about injections. You are always welcome to accompany your child/young person into the anaesthetic room while he/she is going off to sleep. In addition to the general anaesthetic the anaesthetist may sometimes choose to give your child/young person a regional anaesthetic for pain relief purposes. This involves an injection of local anaesthetic, which numbs a particular part of the body. The commonest regional anaesthetic involves an injection of local anaesthetic drug into the lower back (Caudal blocks). This is usually done for operations involving the lower half of the body. It is a well-established and safe method of pain relief for after the general anaesthetic wears off. If your child/young person has a Caudal block he/she initially might be unable to feel fully from the waist down. However, this will only last for approximately 4 hours. The anaesthetist will discuss this with you if your child/young person is having this additional type of anaesthetic.

Modern anaesthetics are very safe and, after the operation, your child/young person will wake up in the recovery room where a qualified member of staff will look after him/her. Once your child/young person has woken up sufficiently and is comfortable he/she will be brought back to the ward to be with you. Further painkillers will be given if required and, in most cases, your child/young person will be encouraged to drink as soon as he/she feels like it. What to expect after the operation Care of young children fitted with a hip spica cast Children under 5 years old will be wearing a hip spica cast when they come back from theatre. The cast will be restrictive and it will take a while for your child to adapt. Please try not to worry about this as the nurses will help you and show you how to care for your child whilst in the cast. During the first few days following surgery, the hip spica edges will be trimmed and taped to aid your child s comfort. It is important to keep your child s skin as clean and dry as possible. You cannot bathe him/her in a hip spica. You may need to use a larger size nappy to fit around the hip spica. Nappies need to be changed more frequently. Casts can become very hot and uncomfortable during hot weather. This can cause skin irritation and rashes, so it is important to keep your child cool and in the shade. You will not usually be able to see your child s wound site as it will be covered by the hip spica. However, if you notice any leakage around the hip area associated with pain and temperature, please contact the Sunflower Ward.

Pain relief immediately after the operation Whilst your child/young person is in hospital the nursing and medical staff will ensure that he/she is as free from pain as possible. Following the operation your child/young person may experience muscle spasms. Medication will be given to help relieve this. Every child/young person is individual and reacts in a different way, but strong painkillers are only usually necessary for the first couple of days. After this time, regular doses of painkillers should keep your child/young person free from pain. Please do not hesitate to consult the nursing staff if you feel that your child/young person is in pain at any time. Help with mobility The occupational therapist will see you and your child/young person on the ward. They will discuss mobility and transport issues with you. The website: www.steps-charity.org.uk contains useful advice regarding car seats plus general mobility and transport issues.

DISCHARGE INFORMATION AND AT HOME ADVICE The following information is a guide to help in the care and recovery of your child/young person after the operation. Constipation following anaesthetic Your child/young person may be a little constipated due to the anaesthetic and lack of exercise. Lots of fruit and fluids added to the normal diet will help prevent this from becoming a problem. Outpatient appointment An outpatient appointment will be arranged usually for 2 weeks after the operation to check the cast (where appropriate) and to have an x-ray. Following this a later appointment will be given for the removal of the hip spica (where appropriate), either at clinic or in theatre - this will be discussed with you. Time off school/nursery (if applicable) Your child will be in the hip spica for 6-12 weeks so may be unable to attend nursery unless you accompany him/her. For older children it is possible to make arrangements for your child/young person to continue school work once they are settled at home. This may be arranged by liaising with your child s/young person s teacher and the hospital school teachers. Treating your child s/young person s pain after operation After the operation your child/young person may be sore for several days. If your child s/young person s behaviour is out of character, eg. he/she cries a lot, is very clingy, unusually quiet or refuses to eat this may be due to pain, or the cast being uncomfortable.

If you think your child/young person is in pain please give the painkillers as directed. Please be reassured that you will not overdose them if you follow these instructions, nor will they become addicted to the medicines. It is best to give the painkillers regularly for the first 3-5 days after the operation and then as needed. Paracetamol - (Calpol, Disprol) This can be given to your child/young person regularly 4 times a day for the first 2 days after going home, and thereafter as needed up to 4 times a day. Give amount as directed on the bottle. Ibuprofen - (Junior Nurofen) Give this to your child/young person as needed up to 3 times a day. It is safe to give both Ibuprofen and Paracetamol together, or alternate Ibuprofen with regular doses of Paracetamol. If your child/young person is asthmatic it may still be safe to give them Ibuprofen as they may have had it in hospital. If you are worried about this please talk to the nursing staff or doctors before you leave. If your child s/young person s asthma gets worse at home, stop using Ibuprofen, but continue with the Paracetamol as prescribed. Rarely, Ibuprofen can cause indigestion, if this occurs stop using it but continue with Paracetamol. Follow the instructions on the bottle for drug dosage. If you do not understand the advice provided, please ask one of the nursing staff or doctors. If your child/young person suffers a lot of pain at home that does not get better with these painkillers, please call Sunflower Ward or your GP. Please ensure that you have these painkillers at home ready for your child s/young person s discharge.

References The first fifteen year s personal experience with innominate osteotomy in the treatment of congenital dislocation and subluxation of the hip. Salter RB, Dubos JP. Clin Orthop Relat Res 1974;98:72-103. Salter s innominate osteotomy in the treatment of congenital hip dislocation: a long-term review. Gulman B, Tuncay IC, Dabak N, Karaismailoglu N. J Pediatr Orthop 1994;14:662-6. Bleeding complications following percutaneous tendoachilles tenotomy in the treatment of clubfoot deformity. Dobbs MB, Gordon JE, Walton T, Schoenecker PL. J Pediatr Orthop. 2004 Jul-Aug;24 (4):353-7. If you have any queries, or require further information please telephone the Sunflower Ward on 01332 786856.

www.derbyhospitals.nhs.uk Trust Minicom 01332 785566 Any external organisations and websites included here do not necessarily reflect the views of the Derby Hospitals NHS Foundation Trust, nor does their inclusion constitute a recommendation. Reference Code: P1045/0192/11.2013/VERSION5 Copyright 2013. All rights reserved. No part of this publication may be reproduced in any form or by any means without prior permission in writing from the Patient Information Service, Derby Hospitals NHS Foundation Trust. (P0573/11.2009/V4)