VDRO (Varus Derotation Osteotomy)

What is VDRO (varus derotation osteotomy)?

Children with spastic or weak muscles or who are unable to walk often develop hip dislocation over time. In a normal hip, the ball-shaped head of the femur is completely contained in the cup-shape socket of the pelvis. When the ball is out of the socket, it’s dislocated. VDRO is a surgery designed to adjust the ball of the femur so it fits into the hip socket.

VRDO usually is suggested if the hip is more than 30 percent out of the socket and likely to get worse. If the hip becomes half or fully dislocated, it can become painful for your child as he or she grows. If a hip has been dislocated for years, putting it back in the socket may not be possible.

Children with dislocated hips and abnormal muscle tone often feel very stiff. Your child may have difficulty sitting properly. It makes tasks such as getting dressed or diaper changing difficult.

How VDRO surgery is performed

This surgery changes the angle of the top portion of the femur to help put the ball of the hip deeply into the socket. Cutting the bone of the femur under the “neck” portion and changing the angle helps with this.

Once the ball is moved into the socket, an assessment is made in the operating room to decide whether a separate procedure is needed to correct the socket angle. The socket may have been stretched so much over time that the ball no longer fits snugly. In this case, the socket must be carefully reshaped to match the ball.

When complete, the ball is deep in the socket and the socket is properly shaped to fit the ball. The opposite side often also needs at least the ball angle changed to keep the legs even.

Follow-up care

There is almost always a cast placed after VDRO surgery. The purpose of the cast is to steady the hips and help control pain.
Once your child is able to go home, the hospital will arrange for:

  • A reclining wheelchair for a month or so after surgery.
  • A special car restraint apparatus.

Your child may attend school in the cast if the school is willing to care for him or her. It may help if a family member accompanies your child on the first day or two of school to show them the routine.

The cast is left in place for 2 to 3 weeks after VDRO surgery and removed at the doctor’s office. An X-ray is made to show the hips in the new position. Your child will have another few days of discomfort as he or she adjusts to being able to move the hips after weeks of being still.

At this point, your doctor will provide a new prescription for therapy. Your child should be encouraged to move the legs and should be encouraged, but not forced, to stand.

Kids tend to draw their knees up for a while after the cast is removed, risking contraction in this position. Keeping their knees straight as often as possible after the cast is removed prevents this from happening. Knee immobilizers often are prescribed. Water therapy or a warm bath are very helpful in relaxing the stiffness.

If your child has a standing, walking and sitting hip (SWASH) brace, it should be worn 12 to 16 hours a day after the surgery to keep the knees apart and prevent the hip from moving out again. If your child does not have a SWASH, you might ask for an abduction pillow, or place a pillow or blankets between your child’s legs at night while they are sleeping.

The hips will stick out more on the sides than they did before the surgery. This is normal. It is because the shape of the bone was changed to point the ball back toward the socket. In a very thin child, this area is prone to bruising due to the prominent bone underneath — just like knees and elbows.

Future outcomes

After recovery, your provider will monitor the hips regularly. The same forces that caused the hips to displace the first time could cause it to happen again. Your doctor may recommend removal of the plates and screws to allow for growth. Removal of the hardware does not cause or prevent the recurrence of the dislocation. The underlying disease process causes it.

If your doctor chooses to remove the plates and screws, this is usually done between six and 24 months after the initial surgery, and is most commonly necessary in a child under age 8 at the time of the initial surgery. Hardware removal is an outpatient procedure, usually taking an hour or so, and does not require casting.

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