Hip reconstruction surgery

Why is hip reconstruction surgery necessary?

Children who have difficulty standing and walking are at increased risk of hip problems. The hip joint is made up of a ball and a socket. Reduced standing and walking can lead to the shape of the hip developing differently increasing the risk of the ball moving from under the socket. If this happens it can lead to problems with function and pain.

Normal hip bones

The position of the hip can be improved with an operation to change the shape of the thigh bone, redirecting the ball into the socket. Sometimes it is also necessary to do an operation to alter the shape of the socket to make the hip more secure. These operations can be done at the same time. Often the shape of both hips will be improved in the same operation, even if only one is causing a problem aiming to create balance.

Benefits of surgery include improving the shape of the hip joint,  the walking pattern in ambulatory children, sitting posture and sitting tolerance. The aim is to reduce pain and prevent potential pain in the future associated with the hips.

There are risks, as with any operation and the surgeons will go through these with you. One of  the risk is that the operation may need to be done again in the future.

Your orthopaedic team will discuss the options and what is best for your child and family. You will have the opportunity to ask any questions you may have.

When is hip reconstruction surgery necessary?

The aim is to operate before the hip is fully dislocated when the ball has moved from under the socket. This is not always possible and will depend on your child’s individual circumstances. It is best to discuss this with your child’s orthopaedic consultant.

What happens during the operation?

This operation is done under a general anaesthetic meaning your child will be asleep.

A small cut is usually made in the groin to lengthen tight muscles which restrict movement. A cut will then be made on the outside of the leg. A small wedge of bone is removed from the thigh bone and the ball is directed back into the socket. Plates and screws are used to hold the bones in their new position whilst they heal.

If your consultant has discussed improving the position of the socket then a further cut will be made higher on the pelvis. The bone above the socket is divided and tilted down to cover more of the ball. The wedge of bone taken from the thigh bone is put in the space to hold it in the new position.

What happens next?

You will come to a Pre Assessment Appointment where you will see your Consultant meet different members of  the orthopaedic team. The team will go through each step of the operation and recovery process.

What to expect after the operation?

Your child will need to stay in hospital for around 5 to 7 days. The number of days will depend on multiple factors, including how comfortable they are after the operation and how they tolerate sitting. Your child will be given medication to help with pain and muscle spasms.

Therapy

After hip reconstruction surgery it is important for the bones and muscle to heal in their new position. The therapy team will see your child on the ward after their operation. They will go through exercises, positive positions and things you can do to help your child get the most from their surgery. Exercises will need to be carried out a minimum of 3 times a day. Your local physiotherapist will guide your child’s rehab journey however it is your responsibility to make sure they complete the necessary exercises.

The therapy team at the hospital will speak to your child’s local physiotherapist requesting they see them after discharge and will pass on any important information.

Cast

Your child may have a cast put on at the end of the operation to maintain a positive position. The 2 types of casts are called a spica or broomstick cast and if used will be on for 4 to 6 weeks. The therapists will go through how to look after the cast and care for your child whilst they’re wearing it.

Positioning

If your child is not planned to have a cast they will be given an abduction wedge and gaiters. The abduction wedge is a shaped pillow that sits between the legs to keep them apart. Gaiters are splints worn on the legs to keep them straight. Both help achieve a positive position for healing and should be used day and night for the first 6 weeks then dropping to overnight and when able during the day after this time. When preparing for this operation it is important to consider the level of care and input your child will need afterwards.

Sitting

Your child will be able to sit out in their wheelchair after their operation. We advise to gradually build up their sitting time and limit to no more than 3-4 hours at a time in the first 6 weeks after the operation.  Your child’s hips will be wider following surgery and it may be that they need a different wheelchair for after the operation or alterations making to their wheelchair. If your child is in a spica or broomstick cast then an alternative wheelchair will be organised to accommodate the cast. The hospital therapists will look at this at the pre assessment appointment and make any arrangements necessary.

Standing and walking

Your child will not be able to put any weight through their legs after the operation until they have had an X-ray at around 6 weeks. They will not be allowed to access their standing frame during this time.

You should bring any of  your child’s other splints including foot and ankle splints and hand splints into hospital as it is important they continue wearing these whilst recovering from hip surgery.

Washing and Dressing

Your child will be able to have a shower whilst their wounds are healing but must not be submerged in water such as the bath until the wounds are healed and dry. it may be easier to carry out bed baths initially and what you are able to access will depend on your individual situation. The therapists will discuss the options with you. Your child’s hips will be wider after the operation and it is helpful to bring loose fitting clothes and consider the next size up in trousers.

What happens after leaving hospital?

An appointment will be arranged for you to come back to clinic at around 6 weeks. A hip X-ray will be taken to check the position of the hips and the healing process.  You should have contact from your child’s usual therapists to help settle in back at home.

What happens next?

It is important for your child to keep having regular hip X-rays so their hip development can continue to be monitored. Your child’s hips are still at risk of displacing after the operation therefore you should continue to help them protect their body shape. Hip surveillance needs to continue until they have stop growing.

What happens to the plates and screws?

It is common for the plates and screws to be removed as if your child was to require further surgery in the future there is nothing in the way. Removing the plates and screws will depend on your child’s individual situation and it is not always essential.

If the plates and screws are removed, it is usually best to do this about a year after the initial operation. A small operation is required to remove the plates and screws, but it is much smaller than the operation to put them in. It usually only involves an overnight stay in hospital.

Summary points

• Hip reconstruction surgery may be needed to improve the shape of the hip joint.
• Positioning and exercises after the operation are very important and will have an effect on the overall outcome.
• Your child will not be able to put weight through their legs for around 6 weeks after the operation.
• Your child is still at risk of hip displacement after the operation and you should continue to help them protect their body shape
• If your child is able to walk the operation may make them more comfortable but it will not change the way in which their muscles work