Introduction
A varus derotation osteotomy (VDRO) is a surgery carried out on children when their hip starts to move out of joint, who are at risk of hip dislocation, or who walk with their legs turned in. The VDRO surgery is to help place the head of the femur back into the ball socket of the hip joint.
Preparing for treatment
Children with weak muscles, or who are unable to walk frequently can develop hip dislocation over time. When the hip becomes unstable, surgeons will perform a VDRO. This may be combined with a procedure to reshape the pelvis socket.
Ensure your local therapists know about your child’s upcoming VDRO surgery. If your child is not currently seeing an occupational therapist (OT) or physiotherapist, contact your local service for a consultation - let them know when your child is having surgery.
Advise your child’s school that your child will be having surgery and may be away for a few weeks. Consider advising your work that you may need time off around the surgery date, and also inform family/friends who may be able to help during, and after the surgery.
During treatment
A VDRO is performed by cutting through the upper end of the femur (thigh bone). It is designed to tilt the neck of the femur inwards, so the ball of the femur sits in the hip socket. Surgeons may also correct any turning in of the femur at the same time. A VDRO is usually stabilised with plates and screws to hold the bone in its new position until it is fully healed. The plates and screws may need to be removed approximately two years post-surgery.
Your child will be asleep and under anaesthesia for the operation. On waking, your child will be given pain medicine and (possibly) muscle relaxants. Pain management will be done either by a nerve block, a drip or via oral medicine. If you have further questions about this process, please discuss with your doctor.
After treatment
After the operation, children usually stay in hospital for five to seven days.
Your child may be allowed to weight bear straight away (within their pain limits), while others will have a non-weight bearing period of up to six weeks post-surgery to allow the bone to heal. This will be determined by the strength of the bone, any other surgeries performed and the surgeon’s preference.
Your child will have a brace or hip spica plaster for around six weeks post-surgery. The brace/plaster is used to maintain the leg’s position. It also provides pain relief by keeping the leg supported and still.
Your child will need to be repositioned regularly post-surgery in order to avoid pressure areas. During the hospital stay, your child’s physio or OT will show you how your child can be re-positioned. If your child uses a wheelchair, an OT may adjust its seating due to a change in the width of the pelvis and required leg position post-surgery.
Management
Your child may need some special equipment at home, including a wheelchair and a commode to help with toileting and showering. Your physio or OT can help you and your child post-surgery with advice on
- moving around, showering and with transferring your child
- walking or using a wheelchair, depending on the doctor’s instructions
- strength based exercises to do with your child when relevant
You will need to give your child regular pain medication at home. It is important to give this to them before showering, transferring and toileting. Health professionals will ensure you have adequate pain medication when you take your child home from hospital.
Check your child’s skin regularly for red areas, especially around the edges of the brace/cast as these are painful and can have serious consequences if left untreated.