HIP OSTEOTOMY DIAGNOSIS RISKS RESULTS
Category: Orthopedic Surgery
Abstract : A physical examination performed by a pediatrician or an orthopaedic surgeon
is the best method for diagnosing developmental dysplasia of the hip. Other aids
to diagnosis include ultrasound examination of the hips during the first six
months of life. An ultrasound study is better than an x ray for evaluating hip
dysplasia in an infant because much of the hip is made of cartilage at this ag
A physical examination performed by a pediatrician or an orthopaedic surgeon
is the best method for diagnosing developmental dysplasia of the hip. Other aids
to diagnosis include ultrasound examination of the hips during the first six
months of life. An ultrasound study is better than an x ray for evaluating hip
dysplasia in an infant because much of the hip is made of cartilage at this age
and does not show up clearly on x rays.
Ultrasound imaging can
accurately determine the location of the femoral head in the acetabulum, as well
as the depth of the baby’s hip socket. An x-ray examination of the pelvis can be
performed after six months of age when the child’s bones are better developed.
Diagnosis in adults also relies on x ray studies. To prepare for a hip
osteotomy, the patient should come to the clinic or hospital one to seven days
prior to surgery. The physician will review the proposed surgery with the
patient and answer any questions. He or she will also review the patient’s
medical evaluation, laboratory test results, and x-ray findings, and schedule
any other tests that are required. Patients are instructed not to eat or drink
anything after midnight the night before surgery to prevent nausea and vomiting
during the operation.
Aftercare
Immediately following a hip osteotomy, patients are taken to the
recovery room where they are kept for one to two hours. The patient’s blood
pressure, circulation, respiration, temperature, and wound drainage are
carefully monitored. Antibiotics and fluids are given through the IV line that
was placed in the arm vein during surgery. After a few days the IV is
disconnected; if antibiotics are still needed, they are given by mouth for a few
more days. If the patient feels some discomfort, pain medication is given every
three to four hours as needed. Patients usually remain in the hospital for
several days after a hip osteotomy.
Most VRO patients also require a
body cast that includes the legs, which is known as a spica cast. Because of the
extent of the surgery that must be done and healing that must occur to restore
the pelvis to full strength, the patient’s hip may be kept from bearing the full
weight of the upper body for about eight to 10 weeks. A second operation may be
performed after the patient’s pelvis has healed to remove some of the hardware
that the surgeon had inserted. Full recovery following an osteotomy usually
takes longer than with a total hip replacement; it may be about four to six
months before the patient can walk without assistive devices.
Risks
Although complications following hip osteotomy are rare, there is a
small chance of infection or blood clot formation. There is also a very low risk
of the bone not healing properly, surgical damage to a nerve or artery, or poor
skin healing.
Normal results
Full recovery from an osteotomy takes six to 12 months.
Most patients, however, have good outcomes following the procedure.Alternatives
One alternative is to postpone surgery, if the patient’s pain can be
sufficiently controlled with medication to allow reasonable comfort, and if the
patient is willing to accept a lower range of motion in the affected hip.
Surgical alternatives to a hip osteotomy include:
• Total hip replacement.
Total hip replacement is an operation designed to replace the entire damaged hip
joint. Various prosthetic designs and types of procedures are available. The
procedure involves surgical removal of the damaged parts of the hip joint and
replacing them with artificial components made from ceramic or metal alloys. The
bearing surface is usually made from a durable type of polyethylene, but other
materials including ceramics, newer plastics, or metals may be used.
• Arthrodesis. This procedure is rarely performed as of 2003, but is
considered particularly effective for younger patients who are short in stature
and otherwise healthy. Arthrodesis relieves pain by fusing the femoral head to
the acetabulum. It has none of the limitations that a joint replacement or other
procedure imposes on the patient’s activity level. An arthrodesis is especially
suited for patients with strong backs and no other symptoms. The procedure
generally requires internal fixation with a plate and screws. The patient may be
immobilized in a cast while healing takes place. An arthrodesis can be converted
to a total hip replacement at a later date.
• Pseudarthrosis. This procedure is also called a Girdlestone operation. A
pseudarthrosis involves removing the femoral head without replacing it with an
artificial part. It is performed in patients with hip infections and those whose
bones cannot tolerate a reconstructive procedure. Pseudarthrosis leaves the
patient with one leg shorter and usually less stable than the other. After this
procedure, the patient almost always needs at least one crutch, especially for
long-distance walking.
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