If you’re a newer follower, or unfamiliar with Maura’s journey with Hip Dysplasia, here are a few links to fill you in.
- When it Rains, It Pours (Maura’s Diagnosis)
- Closed Reduction – Day of
- Spica Life – Week 1
- Spica Care
- Cast Change Day
- Hip Hip Horray- It’s Cast OFF Day
- Life in the Rhino
- Brace Free (for all the wrong reasons)
This catches you up to last year, when progress stopped and all appointments started to blur together with the same news.
As you know, we met with a new orthopedic surgeon, Dr. Cook, on Monday at the University of Rochester Medical Center. I am happy to report that the new doctor is terrific, and he is now ‘our’ ortho. I have canceled all future appointments with our previous doctor and I’m never looking back. As I said last time, I left several appointments in tears and confused about what was going on with Maura’s hips, despite asking numerous questions. I can say that I left our meeting with Dr Cook sad, but informed and hopeful for Maura’s future. Although there are still unknowns, as there always seems to be with this diagnosis, I know what the plan is going forward – which makes me feel so much more comfortable than I’ve felt in the past year, despite the fact that we are most likely facing a rather large surgery within the next year.
The goal of Maura’s first procedure (the closed reduction), was to fit her femur head tightly into her hip socket and wait for her socket to grow around the femur head. A child’s socket grows in reaction to contact with the femur head. If the femur head is lose, as Maura’s once was, the socket doesn’t know where to grow and therefore doesn’t curve down around the femur allowing it eventually to dislocate. Maura’s had been dislocated for a while before we received a diagnosis. Once her hip was in the socket, the purpose of the cast is to hold the bones in place while they grew. Her hip socket formed enough to hold her femur in place with full range of motion. In 90% of children, getting the femur in the socket it all it takes for the body to do the rest. Unfortunately, Maura is one of the 10% … we don’t know why, but Maura’s hip stopped curving around the femur. Instead of a tea cup shape, we’ve got a saucer. Based on the lack of progress this past year, Dr Cook sees very little chance that it will suddenly change course for us to avoid surgery – although we are going to wait until May for one last xray just in case.
The procedure he wants to do is called a Dega Osteotomy. An osteotomy is essentially a re-shaping of bone. I think this website explains the procedure the clearest.
The good news, is Dr Cook does not like to use Spica casts unless absolutely necessary. He doesn’t think she would require a cast afterwards! This eases my mind tremendously, although I know either a brace or abduction pillow/wheelchair would still be needed. I have been worrying about how I would manage to lug around an almost 3 year old in a body cast when a 9 month old was hard enough!
Dr. Cook prefers doing the osteotomy between the age of 2 and 3. Bones grow rapidly in babies and slow as we age. At age 4, the growth potential declines. Getting the surgery done before age 3 lets us use the bones growth potential to heal faster and grow on its own with the help of the surgical changes. The more growing on it’s own that the hip does, the more natural the socket ends up – and the less chance of problems down the road.
I’ve had a couple people ask if the surgery is really necessary. Yes, it is. Maura is not currently in pain. But as her hip sits, it’s not able to take the repeated stress that a healthy hip can. She would most likely begin to experience hip pain and arthritis in her later teens or 20s and need a hip replacement shortly after, and again later in life. Without this surgery, we’d be denying her the choice to become an athlete, we’d be taking away quality of life at a time she should be having fun with her friends, dating, traveling, job searching, etc. If her hip doesn’t correct itself in the next year, it is not going to correct itself. It’s hard to think about putting a toddler through extensive surgery, but it’s harder to think that by not doing this for her, her quality of life would be severely effected. As obesity and many health issues are on the rise, my goal is to raise Maura with the highest chance of living a long and healthy life. Unfortunately, this surgery is part of what we need to do to keep her healthy and happy long term.
Looking back at this smiling face through our journey, makes the future look a little brighter.