Mar 11, 2009

Orthopedic Follow Up

Ainsley had so much fun bouncing this light up eye ball.

We're pretty thrilled that she's learned to throw a ball.

The current x-ray of Ainsley's hips.

Wednesday we had an x-ray of Ainsley's hips to see if they are still in the hip sockets, followed by an appointment with her orthopedic surgeon. The x-ray seemed to show they were still in place at this time however he is concerned that the sockets themselves don't seem to be forming around the leg bone as much as he'd hoped. He is afraid they will slip out over time either partially and cause pain or fully and cause an unusual and difficult gait.

Since Ainsley was going under anesthesia the very next day he checked to see if he could add on an arthogram to the surgery schedule. He injected her hips with dye and then watched to see where that dye traveled when her legs were moved in different positions. Unfortunately her left hip shows some movement of the leg within the socket which is likely to lead to dislocation.

Regardless her hip sockets are too shallow to hold her legs into place. The hope was that after her last hip surgery, spica cast and hip brace that the leg bones being fixed into the sockets would prompt the sockets to form more deeply in response to the pressure. Unfortunately it didn't work.

The next step is a rather long surgery where they take bone from another part of the body (hopefully the pelvice) and use it to reconstruct hip sockets by cutting the existing hip apart and curving it downward. At the same time he would do a double osteotomy where he cuts and reshapes her thigh bones. After the operation she would be fitted into a hip cast for 6 weeks. After the cast came off she would be in a hip brace for another 6 weeks. It is expected that it would be 2 months before she could put pressure on her hips because of pain. And in all the surgery is likely to take 6 months for her to recover from developmentally. Meaning in addition to not making gains, it would likely take 6 months for her to simply be doing what she was prior to the surgery.

He said that if Ainsley were a typical child there is no question we would want to move forward with this surgery. But he doesn't want to put her through this if she isn't going to walk. The analogy he used is a car with wheels out of alignment. If your wheels are out of alignment and you bring the car out occasionally for 300 miles a year the tires will last forever but if you drive a lot miles per year the tires are going to wear out quickly and cause a big problem. So basically we have to try to figure out if she's going to be a regular driver or just your Sunday driver. I feel more than ever that she will walk on some level, even if it's with a walker just around the house. He says that even if that is the extent of her walking that it would be best for her hips to be in place.

Dr. Song likes to pay careful consideration to a disabled child's development when planning a surgery like this. He wants to see her back in 3 months to do another x-ray. We'll see how the hips look and what she is doing developmentally and then we will decide what the plan is. She's been doing so well I too hate to set her back by doing this surgery now but I also would hate to wait until she is walking and then have to immobilize her. The mostly likely timing would be this fall or next spring, taking care to avoid being in the hospital during cold and flu season due to her airway.

I was really saddened to know that the previous treatments didn't work and she went through all that for nothing. And now to be faced with yet another major surgery is very hard to stomach. Ainsley has been through SO much already and she is such a sweet natured child, it seems so unfair. It's very unlikely but I'm still holding out a small amount of hope that somehow, some way, things will have improved slightly by the next x-ray. Although that may just make the decision that much harder. I think we're still in a little bit of denial that this thing is really going to have to happen.

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