Children with neurological disorders often experience spasticity, which can cause issues for the hips. What is VDRO, and how does it help kids?

Published: October 22, 2020 | Updated: September 25, 2021

Children with various neurological disorders such as cerebral palsy, spina bifida, spinal muscular atrophy (SMA), muscular dystrophy and Charcot-Marie-Tooth disease can be at risk for hip dislocation. What is varus derotation osteotomy (VDRO), and how does it help children with neurological disorders?

Children with neurological disorders can have spastic or weak muscles. Spasticity in muscles means that the muscles are continuously contracting, which causes stiffness or tightness in the muscles. Children who experience spasticity may have trouble walking or may be unable to walk at all. This can cause hip subluxation. Hip subluxation means the ball of the hip moves away from the socket over time. This can cause pain when moving and difficulty with walking, standing and positioning in the legs, which can cause deformity over time. When the hip becomes unstable to the point where the hip is more than 30% out of the socket, a pediatric orthopedist may suggest a surgery called varus derotation osteotomy (VDRO). The surgery places the ball back into the socket of the hip. The procedure helps prevent a partial or full hip dislocation, which can cause pain for a child as they grow.

How does VDRO help children?

The answer is by putting the hip back in the socket. The hip can be in one of three positions: located/normal, completely dislocated or perched/partially dislocated. Being perched or partially dislocated leads to pain and limitation of motion with increased risk of fractures (breaks) as time goes on.

So, how does VDRO help children? It puts the hip back in the socket, improving the chance of having the hip in the correct position as an adult.

What happens with VDRO?

A pediatric orthopedist cuts the outside of the hip. A small piece of bone will be removed from thigh bone, to allow the head of the femur (the ball of the hip) to be angled to rest inside of the socket. Each joint is surrounded by a capsule, and depending on a child’s condition, the surgery may be:

• Closed reduction: This means that the pediatric orthopedist can place the ball inside the socket without opening the capsule.
• Open reduction: The pediatric orthopedist needs to open the capsule to place the ball inside the socket.

When the surgery is completed, a child almost always is placed in a cast to help steady the hip as it heals. The cast also helps with pain. A child also will need to use a reclining wheelchair and a special car seat to travel for an amount of time after the surgery.

Pediatric orthopedic care for neurological disorders

Norton Children’s Orthopedics of Louisville, affiliated with the UofL School of Medicine, provides specialized orthopedic care for children experiencing neurological conditions, such as spina bifida. Its physicians are a part of multidisciplinary teams for several specialized clinics for children with neurological conditions, including spina bifida and cerebral palsy.