Claudia was born full-term, the second child, of a normal pregnancy. The only problem was that Claudia aspirated meconium while still in utero and had to spend 4 days in intensive care. Once home things were fine and not one of the 4 different pediatricians that saw her in the first few days discovered her hip problem.
At her nine months check up I mentioned to the pediatrician my concerns about the way Claudia’s legs, especially the right one, turned out. We were given a referral to an orthopedist, but not a pediatric orthopedist. The orthopedist simply felt her legs and hips with his hands and did not take x-rays. He pronounced her fine and said I was worrying needlessly.
At the 15 months well baby check up I again brought up my concerns. Claudia had been pulling up to stand since she was 9 months old. Yet in all that time from 9 months to 15 months she was unable to take a step by herself without holding on to something. She would cruise around furniture going sideways but never going forward. I found out later that in a child that has bilateral (both hips affected) DDH the inability to take an unassisted step forward is a common sign.
We were referred to a pediatric orthopedist and within minutes of being in the exam room he was able to tell us that he suspected she had CDH (oftentimes called DDH now). Based on his physical exam and all that we told him about the way her legs turned, the inability to walk, etc. he diagnosed her with bilateral congenital dysplasia of the hip with acetabular indexes of 45 degrees in each hip. He took x-rays which confirmed his diagnosis.
Arrangements were made for her to enter the hospital the following Monday for skin traction of her legs. This was on a Thursday. When we entered the hospital, long pieces of a special tape with a metal bar that went across her instep were taped to both sides of her legs from her thigh to her ankle. Over top of this was wrapped ace bandages. The weights were attached to ropes that connected to the bar at her foot. She was attached to the traction for 8 days and was allowed out to eat her meals in a high chair. Other than that she stayed attached to the weights.
After 8 days, Claudia’s ortho determined that her muscles and ligaments has loosened up enough for him to do the operation. Since she was so old when the DDH was discovered, her femurs had been trying to make a hip socket about two inches above the normal spot on the pelvis. In that time the muscles and ligaments tighten up. During the operation the ortho performed an adductor tenotomy. This means that he cut the tendons on the inside of her legs to allow the femur to be placed in the correct spot on the pelvis. He was able to perform a closed reduction because there was no socket at all so there was no place for cartilage to collect. Then he put her in a hip spica cast which went from her armpits to her toes. She was in the shape of a staple.
Six weeks later he changed her casts. It was at this time that he determined that she would need three sets of casts for a total of almost 19 weeks in body casts. One good thing was that each time the casts got smaller- her first cast went to her toes, the second one went to her ankles and the third one only went to her knees, she had spica shorts. After her third cast came off, Claudia’s doctor decided that her acetabulums were still too shallow. Her acetabular indexes were in the low 30’s after 19 weeks of casts. She was put into a walking abduction brace.
Claudia wore the brace 24 hours a day for the first 5 months. After 5 months she was allowed to sleep without the brace, but she was not allowed to stand or put any weight on her legs without the brace. Six weeks after getting the braces Claudia took her first unassisted step. She walked like a cowgirl as we liked to say, but at least she was walking!!
After she had been in the braces for about two months the ortho started talking once again about the possibility of Claudia needing osteotomies. The braces were helping some but there was still a long way to go to get full coverage of her femurs. We continued to have her wear the brace all of her waking hours, but four months after starting the braces it was apparent that no more progress had been made. Her acetabular indexes were 28 degrees on the left and 35 on the right.
2 ½ months later (total of 7 ½ months in the braces), after we had gone for two additional opinions, Claudia had bilateral pelvic Salter osteotomies. In this operation the ortho takes a graft of bone from the rounded hip area. The doctor makes a cut through the bone above where the femur rests and inserts the bone graft. One or two 2-4 inch pins are inserted through all the pieces of bone to hold everything together. Then Claudia was back in a hip spica cast from her armpits to her toes again for 7 weeks.
The osteotomies were not tolerated well by Claudia. The surgery was 4 ½ hours long and anytime she has to have anesthesia for any length she gets very sick. So she was throwing up for two days and she had muscle spasms. The ortho ended up ordering a narcotic to let her sleep which was put into her epidural to help her recover. Once we were released from the hospital, Claudia started to become her old self about 14 days post-op.
She developed an infection in the pins in her left hip. She still has a scar on top of the osteotomy scar on the left side from the infection. Seven weeks later Claudia went back to the hospital to get the pins taken out and also to have the cast removed. Her doctor did not order any physical therapy since he felt that the normal crawling, pulling up, playing, etc. would be enough for her legs.
She started to walk without any help 5 weeks after the pins came out and the casts came off. We were so thrilled, it was something I wondered if I would see. We went back for check-ups every few weeks at first, then every three months, then every six, now she goes for a once a year check-up and will continue to be checked until she has completed her growing. It was a long trying road, but my daughter is now fine. She remembers much of the ordeal, and still talks about it five years later, but she is healed and hopefully will not have any additional problems related to the DDH.
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