When the hip is dislocated in an infant or child, and brace treatment has failed then surgery may be required to reduce the ball into the socket. The surgery that is performed is called a medial open reduction.
A medial open reduction is an operation that involves making an incision on the inside of the groin to remove all the blocks to reduction between the ball and socket.
This is done after Dr Balakumar thoroughly explains the condition and treatment to your family. The child is then taken to the operating theatre and put asleep. Melbourne is one of the safest places for your child to have an anaesthetic. Once your child is asleep, the anaesthetist may choose to give your child a caudal block (very similar to a spinal).
Dr Balakumar will then prepare and drape your child. He will make an incision over the groin crease and pass between nerves and vessels to find the hip joint. The blocks to reduction will be found and removed. This includes the adductor longus tendon (the muscle on the inside of the groin), the psoas tendon (the hip flexor muscle), the ligamentum teres is cut and sutured to hold the reduction.
In the base of the socket all soft tissue caught between the ball and socket are removed. Dr. Balakumar will then place the ball back into the underdeveloped socket and secure it there with a suture. Once the ball is in the socket, the socket still has opportunity to grow normally if it is stimulated appropriately positioned. The incision is then sutured and a hip spica cast is applied. This is a whole body cast. Most parents are very anxious about the whole body cast. This is a normal reaction, however rest assured that most parents and child will adapt to this cast very well. The cast is usually required for 3 months. However the cast is changed under anaesthetic at the 6 week mark. This is normal as the child grows.
The child usually spends two days in hospital and may leave earlier or later. If the hip is still unstable despite the open reduction or if the child presents later, then a pelvic or femoral osteotomy is often added to aid in the recovery. Most children will have either a MRI scan or a CT Scan to help verify the appropriate position of the hip after surgery.
Complications of the surgery include infection, nerve, vessel damage, cast rash, urine rash, and reactions to the cast or pressure areas. Other complications include re-dislocation.
It is important to emphasize that this operation only deals with the dislocation, which over time may help deal with the underlying dysplasia. However if the dysplasia persists then the child may require joint re-alignment operations.
64 Chapman Street
North Melbourne VIC 3051
Ph: (03) 9329 5525
Fax: (03) 9329 4969
Melbourne Orthopaedic Group
33 The Avenue
Windsor VIC 3181
Ph: (03) 9573 9659
Fax: (03) 9521 2037
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© 2012-2014 Jit Balakumar - Paediatric & Adult Orthopaedic Surgeon, Melbourne
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