Post-Operative Care Tips for Children After Hip Dysplasia Surgery

Q: Post-Operative Care Tips for Children After Hip Dysplasia Surgery

Hello： Typically, a cast is worn for 6 to 8 weeks, with the removal of pelvic (acetabular) screws around 8 weeks, and the osteotomy site takes about 12 weeks to heal. <br>After the cast is removed, do not allow the child to walk immediately. <br>Older children can be taught to us

I would like to inquire about the postoperative care for children with developmental dysplasia of the hip?

Hello Doctor: My daughter is 5 years old and underwent corrective surgery for hip dysplasia on May 4th of this year.
The cast was removed on June 13th, and on June 17th, she had a second surgery to remove the pins, meaning the entire surgical process has just concluded.
She is currently receiving home care and is mostly lying down (either on the bed or on a mat).
I would like to ask you about her postoperative leg positioning, movement precautions, and rehabilitation:
1.
I have observed that her legs are often in a flexed position, and one knee tends to collapse inward.
When I ask her to open her knees outward, she is unable to do so.
Is this situation normal? Additionally, what specific leg positions or movements should we avoid to prevent any displacement of her bones?
2.
Is it currently permissible for her to attempt to turn over or sit up by herself?
3.
Does she need to engage in any rehabilitation exercises at this stage? Typically, how long after surgery should she be able to practice sitting, standing, and walking?
4.
Generally speaking, after this type of surgery, is it common for children to regain normal movements after some time? Is there a possibility of the hip dislocating again?
Thank you very much for your answers!

Meimei, 0~9 year old female. Ask Date: 2022/06/18

Dr. Li Wenhong reply Orthopedics

Hello: Typically, a cast is worn for 6 to 8 weeks, with the removal of pelvic (acetabular) screws around 8 weeks, and the osteotomy site takes about 12 weeks to heal.
After the cast is removed, do not allow the child to walk immediately.
Older children can be taught to use a walker for assistance.
Most children will not get up in the first few days after the cast is removed; do not force them to exercise.
Allow them to perform active and passive range of motion exercises at their own pace.
During passive movements, you can gently stretch to the normal position, but avoid excessive bending (allow the child to actively bend to a comfortable position).
If the child wants to turn over or sit up by themselves, that is acceptable.
Within 2 weeks after the cast is removed, they can practice sitting and using a walker to practice standing, and depending on the situation, practice walking.
It is recommended to seek assistance from a rehabilitation specialist.
If normal activity is restored after surgery, dislocation of the hip is rare.
As for the positions of adduction and flexion of the lower limbs immediately after cast removal, this is normal because the child has just been freed from the cast, and such positions may feel more comfortable.
You can gradually encourage them to abduct and straighten their limbs.
This type of surgery should be regularly monitored for healing at the osteotomy site and the development of the acetabulum, so it is advisable to consult the attending physician during follow-up visits.
Changhua Hospital Orthopedics Dr.
Li Wen-Hong.

Reply Date: 2022/06/18

More Info

Post-operative care for children after hip dysplasia surgery is crucial for ensuring proper healing and recovery. Your daughter’s recent surgeries, including the correction of hip dysplasia and the removal of hardware, require careful attention to her movements and rehabilitation. Here’s a comprehensive guide addressing your concerns:
1. Leg Positioning and Movement: It is common for children to exhibit flexed knees and inwardly rotated legs after being in a cast for an extended period. This is primarily due to muscle tightness and the body’s adaptation to the immobilization. While it may seem concerning, this positioning is often normal immediately following the removal of the cast. However, it is essential to encourage gentle stretching and passive range-of-motion exercises to help her gradually achieve a more neutral leg position. Avoid forcing her knees outward, as this could cause discomfort or distress. Instead, you can assist her in slowly moving her legs into a more extended position, ensuring she is comfortable throughout the process.

2. Self-Movement: If your daughter wishes to roll over or sit up, it is generally acceptable as long as she does so gently and without excessive force. Encourage her to move in a way that feels comfortable, and provide support if necessary. It’s important to monitor her movements to ensure she does not put undue stress on her healing hips.

3. Rehabilitation Exercises: Post-operative rehabilitation is vital for restoring strength and mobility. Typically, children can begin gentle rehabilitation exercises within a few weeks after surgery, depending on their specific recovery progress and the surgeon’s recommendations. Initially, focus on passive movements and gradually introduce active movements as she becomes more comfortable. Sitting, standing, and walking can usually be introduced around two weeks after the cast removal, but this should be done under the guidance of a physical therapist. A tailored rehabilitation program will help her regain strength and improve her range of motion.

4. Risk of Re-dislocation: After hip dysplasia surgery, the risk of re-dislocation is generally low if the surgery was successful and rehabilitation is followed correctly. However, it is essential to adhere to the post-operative guidelines provided by your surgeon and physical therapist. Regular follow-up appointments will allow the medical team to monitor her recovery and address any concerns promptly.

In addition to these points, here are some general post-operative care tips:
- Pain Management: Ensure that her pain is managed effectively with prescribed medications. Pain can hinder her ability to participate in rehabilitation exercises.

- Activity Restrictions: Avoid high-impact activities and excessive weight-bearing until cleared by her healthcare provider. This includes running, jumping, or any activity that could put stress on her hips.

- Follow-Up Care: Regular follow-up appointments are crucial for monitoring her healing process. These visits will help assess the alignment of her hips and the overall recovery progress.

- Emotional Support: Recovery can be a challenging time for children. Provide emotional support and encouragement to help her cope with the changes in her mobility and activity levels.

In conclusion, while your daughter’s current leg positioning may seem concerning, it is often a normal part of the recovery process. With appropriate care, rehabilitation, and monitoring, she can achieve a successful recovery and return to her normal activities. Always consult with her healthcare provider for personalized advice and recommendations tailored to her specific situation.

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