Gabriella's hips were checked at birth by the pediatrician (3/12/1998) in theatre, as there is a history of Hip Dysplasia in my husbands family, my father-in-law was diagnosed in his early thirties and my sister-in-law was treated at the age of 5 ½ months old.
We were told that the hips were both dislocatable and she was put into a Pavlik harness before she was 24 hours old! Having never experienced this before we were referred to an orthopedic surgeon in the hospital in which she was born. She wore the Pavlik Harness 24/24 hours for the first 6 weeks. He saw her at a week old, then again two weeks later and two weeks after that. At this visit we were told that in a weeks time, we could remove the brace for two hours a day and to come back two weeks later! At the age of 7 weeks, we were sent for x-rays, and sent home. She was in the pavlic harness for a total of 12 weeks, at which stage we were told that her left hip appeared to be stable and that although the right hip wasn't "quite what we wanted" to take her home and bring her back in 4 months time!
TWO days later, I got a phone call to say that "WE have decided that she needs to be in plaster for between three and six months" - closed reduction! Firstly, I was upset that he hadn't bothered to ask to meet to discuss the matter. Secondly I was angry because he hadn't told us that he was going to bring her case up in a forum of orthopedic doctors who meet at a government hospital every week!
Gabriella had a closed reduction and had the plaster changed at 6 weeks, and at 3 months, we were told to go home and "get more baby". We were told to come back again after she was a year old and he would do an open reduction. I went and got another opinion and he also agreed that an open reduction was needed, so we decided to stay with the first doctor.
On 11 January, 2000 Gabriella had an open reduction done and he did an osteotomy (Salter, I think), at the same time, where he cut the top of the socket and wedged it down with a piece of bone. He said that no pins were used as there wasn't enough bone! Six weeks later when the cast was changed, she was in the new cast for no longer than three days when she had to go back and have the cast strengthened as it cracked. He applied another layer of the cast, and when I mentioned that both Craig and were concerned because it felt like there was a bone sticking out of her bottom that became more prominent when changing her nappy and picking her up! He told me not to worry and that I was being neurotic, he never checked up on her while in plaster and only saw her at the end of the six week period! After three months in the plaster cast, he came out of theatre (He had been accompanied by a professor of orthopedic surgery) and told us that it was not right and to bring her back when she was walking (Again - 2nd time)
We went back to the first doctor again when she was walking, and after looking at the latest x-rays, his words were "We will have to do the operation again", when I asked what part of it (the open reduction or osteotomy), his reply was "both". He was so sarcastic at that visit, he said to me "Mrs Rowan, you look pregnant with questions" and my response was "No doctor, my husband will be asking the questions this time thanks".
We never went back to that doctor, as he treated me with disdain everytime I dared to ask a question about the treatment and progress, or the lack thereof.
I went back to the second opinion doctor - two hours later - the one I had seen the previous year and we have been with him every since then. We have a very good doctor/patient relationship and he always takes time to talk to us about what he has found and how he thinks we should proceed from here and what our options are! On top of which he is very good with Gabriella and now that she can answer for herself, that is a great help too!
On 20 September 2000, he did another open reduction - where he cut the one tendon and tightened the other one, put Gabriella into a spica for 6 weeks, and thereafter she wore a bachelor cast from her thighs to her ankles for another 4 ½ months and when he took that off, she never looked back. She walked in the bachelor cast for the third time, she jumped, climbed stairs, almost ran and developed beautifully. Her socket has developed 5 - 10 degrees since the bachelor cast was removed and our last check-up was in November last year - having started with check-ups every two weeks, then three weeks, then six weeks and then 12 week intervals, we have now progressed to a six month interval and have 5 degrees to go until he will be happy with the coverage she has.
The ortho has also commented to us that her hip appears to have a fairly flat head, and although that could be reason for concern, her left hip has the same appearance, so that may just be in her genetic make-up!
Our next check-up is on the 10th of May, where I guess we will be given good or bad news. Although she is developing exactly as she needs to be, my greatest fear is that she will still have to have another osteotomy!
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