The following patient information sheet is meant to help patients and family better understand a specific pediatric orthopaedic condition. It is not meant to be comprehensive, and only reflects one viewpoint. This page does not replace a medical evaluation by a pediatric orthopaedic surgeon, and your own surgeon may have a different approach to your condition.
What is an osteotomy?
Osteotomy means that the bone has been divided into two segments. In general, the bone is either shifted, or a wedge is removed or inserted to change the shape of the bone. It is then held in position with plates and screws, rods, wires and or casts until it heals.
When are osteotomies of the pelvis necessary?
The hip joint is a ball and socket type of joint. The pelvis represents the socket, while ball comes from the end of the femur (thigh) bone. The amount that the pelvic socket covers the ball is the coverage of the joint. Pelvic osteotomy is most commonly performed to increase coverage of the hip joint.
What can I expect with pelvis osteotomy surgery?
There are multiple types of pelvic osteotomies, and the particular type chosen is based on a child’s age, pelvic shape and the goals of surgery.
One or more incisions are made about the hip. These incisions tend to hide fairly well due to the location. Sometimes muscles need to be lengthened at the same time to allow the hip to pass into a proper position and to obtain flexibility. One or more bones in the pelvis are cut and reshaped. In some cases no metal implanats are necessary, while in other cases pins or screws are used. If pins are placed, they are generally removed in six weeks with a minor surgery.
Younger children are often placed into a spica cast. This is a body cast which extends from just under the ribcage down to the foot on the surgical leg, and down to the knee on the other leg. A hole is cut for bathroom use.
Your child is restricted from eating for the first day after surgery. Diet is then gradually resumed. A typical hospital stay is 3 to 4 days.
Your child is only allowed to touch his or her foot to the ground for balance for the first 6 to 10 weeks after surgery. After that time weightbearing is gradually increased based on examination and the amount of healing seen on x-rays. Normal walking generally starts 3 to 4 months after surgery.
What are the risks of surgery?
The most significant risk is that child continues to have problems with the hip despite a technically successful surgery. The risk of this depends on the hip condition being treated, and should be discussed prior to surgery.
When only a single bone is cut, healing almost always occurs. When multiple bones are cut, one of the bones can have delayed or incomplete healing, rarely requiring repeat surgery.
Bleeding does occur with pelvic osteotomy surgery. In some cases, a blood transfusion is performed during surgery or the days afterwards.
There is a nerve called the lateral femoral cutaneous nerve which passes through the surgical region. Occassionally, this nerve is stretched or injured, leading to numbness or pain over the upper thigh. Rarely, the numbness is permanent, although it does not tend to cause any functional issues.
Other nerve and blood vessel injury, joint stiffness, infection and wound issues are all quite uncommon with hip osteotomy surgery but all possible. General anesthesia always carries some risk although complications of anesthesia are also uncommon.