Developmental Dysplasia of the Hip: Surgical Options and Care

Inquiry about DDH (Developmental Dysplasia of the Hip) issues?

Hello Doctor, my daughter just turned three years old.
She was diagnosed with congenital hip dysplasia when she was two months old.
She wore a harness for eight months during her first year.
We recently visited the doctor, who mentioned that the angle is still not very good.
The normal angle should be 20 degrees, but currently, it is 26 degrees, and if it reaches 30 degrees, surgery will be necessary.
We are considering whether to wait and see if it will improve on its own or to proceed with surgery.
The doctor recommended a "Pemberton osteotomy" for children and suggested that we research the procedure online, but there is limited information available, and it is quite technical.
I would like to ask the following questions:
1.
If we proceed with the surgery, will she be in a cast for one month after surgery, and will it take 3-6 months before she can walk, or can she walk as soon as the cast is removed?
2.
After the cast is removed, will she need to wear any type of brace for stabilization? How should we care for her during this time?
3.
The doctor mentioned that we can observe until she is four years old.
Would it be better to have the surgery sooner, or can we wait until she is four?
4.
Will she be fully recovered after the surgery, or is there a possibility of future dislocation?
5.
Will she still be able to run and jump in the future?
6.
Is this considered a simple or complex surgery?
7.
How many days of pain can we expect after the surgery?
8.
Will the anesthesia be regional or general during the procedure?
9.
How many days after the surgery can we expect her to be discharged from the hospital?
10.
The issue is with her right leg, but the doctor recommends surgery on both legs.
Could you explain why?
Thank you for your answers, Doctor.

Miss Wang, 0~9 year old female. Ask Date: 2018/04/27

Dr. Shi Guozheng reply Orthopedics

1.
Usually, after removing the cast, you still need to practice walking gradually, as you have to wait for the fractured bone to heal.

2.
Surgery may not be necessary.

3.
If the alignment is poor, surgery is preferable.

4.
The chances of recovery are very high.

5.
You will be able to run and jump.

6.
It requires a highly experienced pediatric orthopedic surgeon; the pediatric orthopedic department at National Taiwan University Hospital has significant expertise in this area.

7.
Approximately one week.

8.
General anesthesia is required.

9.
Within a week.

10.
There may be issues on both sides.

Reply Date: 2018/04/27

More Info

Understanding Developmental Dysplasia of the Hip (DDH) and the surgical options available for its treatment is crucial for parents navigating this condition for their children. In your case, your daughter has been diagnosed with DDH, and the recommended surgical intervention is the Pemberton osteotomy. This procedure aims to correct the hip joint's alignment and improve its function. Below, I will address your questions and provide additional context regarding the condition and its management.

1. Post-Surgery Recovery Timeline: After a Pemberton osteotomy, the recovery process typically involves immobilization in a cast for about 4 to 6 weeks. During this time, your daughter will not be able to walk. After the cast is removed, she will likely need to undergo physical therapy to regain strength and mobility. Walking may begin gradually, often within a few weeks after cast removal, but full recovery to normal activities can take several months.

2. Post-Cast Care: Once the cast is removed, your daughter may need to wear a brace or harness to stabilize the hip joint as it heals. The specific type of brace will depend on the surgeon's recommendations. Care during this period will involve ensuring she does not put undue stress on the hip and follows the rehabilitation protocol provided by the healthcare team.

3. Timing of Surgery: Early intervention is generally preferred in cases of DDH, especially if the hip joint is not developing properly. While some children may improve without surgery, the risk of long-term complications, such as hip arthritis or impaired mobility, increases with delayed treatment. If the angle of the hip is still not within normal limits (20 degrees), surgery may be warranted sooner rather than later.

4. Surgical Outcomes: The Pemberton osteotomy has a good success rate, and many children experience significant improvement in hip function post-surgery. However, there is always a risk of complications, including the possibility of the hip joint becoming misaligned again. Regular follow-up appointments are essential to monitor the hip's development.

5. Future Activities: Most children who undergo this surgery can return to normal activities, including running and jumping, as they grow older. The goal of the surgery is to allow for normal hip function, which is crucial for active play and sports.

6. Surgical Complexity: The Pemberton osteotomy is considered a specialized procedure that requires a skilled pediatric orthopedic surgeon. While it is not the most complex orthopedic surgery, it does require careful planning and execution to ensure the best outcomes.

7. Post-Operative Pain: After surgery, your daughter may experience pain for several days, which can be managed with prescribed pain medications. The intensity and duration of pain can vary based on individual factors and the extent of the surgery.

8. Anesthesia: The procedure is typically performed under general anesthesia, ensuring that your daughter is completely unconscious and pain-free during the surgery.

9. Hospital Stay: The length of the hospital stay can vary but is usually around 1 to 3 days, depending on her recovery and the surgeon's protocol.

10. Bilateral Surgery Consideration: If the surgeon recommends surgery on both hips, it may be due to the potential for bilateral hip dysplasia, even if only one side appears affected. This approach can help prevent future complications and ensure balanced development.

In conclusion, while the decision to proceed with surgery can be daunting, it is essential to weigh the potential benefits against the risks of delaying treatment. Engaging in open discussions with your child's orthopedic surgeon will provide clarity and help you make informed decisions regarding her care. Regular follow-ups and adherence to rehabilitation protocols will be key to ensuring a successful outcome.

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