Sunday, July 27, 2014

Ryan's Left Hip Surgery

Well, tomorrow is the day.  After a lot of prayers, a few delays, and several blessings, we are confident that even though this is going to be really hard, it is medically wise to do this surgery on Ryan.

They will be doing a femoral varus osteotomy with a hip open reduction and a salter osteotomy.  Ryan will then be put in a spica cast for 6-8 weeks.  What does all of that mean?

Well, the upper end of Ryan's thigh bone doesn't sit where it's supposed to be and thus he has a condition called, "hip dysplasia."  This can be a problem for several reasons:  hip dislocation, arthritis can develop, he can have severe pain, and if it stays out of place for a long time, it may become fixed and more difficult to move.

So, one part of the surgery, the femoral varus osteotomy will help by tipping the upper end of the thigh bone so that the ball points deeper into the socket.  According to the International Hip Dysplasia Institute, this will tip the hip into the socket and redirect the forces toward the middle of the socket instead of toward the outer edge of the socket.  In the picture below, you can see the before on the left and the after on the right.

Note the blue hardware.  Ouch.

The doctors will open up the hip joint and clear out any tissue that is keeping the head of Ryan's femur from going into the the hip socket, the acetabulum.  I believe this will be done through the anterior approach.  If you look at the picture below, the black dotted lines represent where they'll make the incisions.

The Salter Osteotomy means that Ryan's pelvic bone will be cut and the entire socket will be rotated into a better position on top of the femoral head after the hip is reduced into the socket.

Below, you can again see the before and after:

The "pins" that look more like really long nails to me make my heart just sink.  If you've ever had a bone drilled into, you'll know that this are not going to feel very good.

During all of this, it is common for children to need a blood transfusion due to blood loss.  And, it's my understanding the surgery will take about 2 hours.

Once they are all done and have him stitched back up, they will put Ryan in a spica cast.  If you want to see an interesting video about how they put on the spica cast, click here for a Spica Cast Video.   I hope they'll be more gentle with Ryan.

This has been a tough decision to make for Ryan.  It's hard to know how a typically developing child would respond to such a major surgery.  It's really scary to think about how Ryan will respond.  What if this slows his progress?  What if the pain is more than he can bear?  What if he just gets whiny because he has pain and doesn't know how to communicate it?  What if he can never ride a tricycle again?


But, the answer to the prayers has been that this is a medically wise decision.  We know that God has always taken care of us and anticipate He'll do the same for us.  We'd love to have your prayers for us, the surgeons, nurses, and especially Ryan.  We'll keep you posted on how things go in the morning.

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