My Stomach Hurts

....And it's not from sticky buns. Ainsley has hip dysplasia in both hips and it requires surgical correction. With all her other medical concerns it's not something I talk about very often. She suffered through a Pavlik harness at birth and later an open reduction on one hip closed on the other and months of being in a spica cast and then more months in an abduction brace. Unfortunately those treatments were ineffective and Ainsley's hip sockets are still not deep enough to hold her leg bones in place which puts her at risk for complete dislocation or painful arthritis later in life.

We've known for quite some time that surgery was in her future if we ever expected her to walk much. The question was when to do it. Although there is a certain appeal to waiting we ended up deciding that it was just delaying the inevitable. Besides, I think that the less mobile she is the easier it will be for her to tolerate being immobilized by the cast and then brace following surgery.  It would be miserable to wear a heavy itchy cast during the summer, the fall would be disruptive to the schoolyear, winter is bad due to illness...so it's now or a year from now. Meanwhile she'd just be getting bigger. Besides if there is any hope of getting her tracheostomy out this surgery has to be done first (you don't want to intubate a delicate airway after decannulation for surgery).

The surgeon was available April 5th, the day after Easter and Spring Break. Although I knew it would likely happen in the next month or so this is a bit of a shock. Perhaps it's good, though, because it gives me less time to worry. This surgery is serious. Here is a description:

A pelvic osteotomy is used when the acetabular index is not improving and there is not adequate coverage of the femur. The surgeon begins by opening the hip capsule up, hence many times the surgery is osteotomy with an open reduction. After the hip capsule is opened, the surgeon will take a wedge shaped piece of bone from the bony protuberance further up on the pelvis. This is the graft bone. Next the surgeon will cut across the pelvis slightly above the acetabulum. The bone graft will be inserted into this cut and held in place with 2 four-inch long pins. Lastly the surgeon will place a spica cast on the child which remains on up 8 weeks. The pins are taken out later, sometimes when the cast comes off and sometimes in a separate operation. The pelvic osteotomy brings the whole acetabulum (socket) down and around without changing the shape of the socket. There are different pelvic osteotomies depending on where the surgeon opens the hip socket (anterior, medial or posterior), where exactly on the pelvis the cut is made and whether more than one cut is made. But the resulting operation is still the same.

A femoral osteotomy is performed when there is adequate coverage of the femur but still the femur can move with the possibility of dislocation. The surgeon begins by opening the hip capsule. The femur is cut all the way across just slightly below the ball area. The surgeon then rotates the top of the femur slightly around towards the acetabulum. The femur is then put back together with a plate and screws. Lastly a hip spica cast is placed on the child which remains on up to 8 weeks. The plate and screws are removed in a separate operation at a later date. The femoral osteotomy rotates the top of the femur around to fit better into the acetabulum (socket) while the bottom of the leg remains unchanged.

Can you see why the thought of them doing this turns my stomach?

After all this is done she will be placed into a spica cast for 6 weeks, then an abduction brace for another 6 weeks. Having already been through this process once before we know what we are in for and it isn't fun. In addition there is likely to be pain, and she will have to rebuild her strength and regain some motor skills which she will likely lose from inactivity. She had pain in her hip for many months following the open reduction and this is likely to be much worse. And,  I suspect this time around she is going to be very unhappy to be stuck in one place. I will try to have her return to school but I'm unsure of the logistics of this. Last time even the special spica cast carseat didn't fit properly. And I have just a week before this starts. The only good thing about doing this surgery is that it will another surgery behind us.