I live in the UK and they do things slightly differently here. Our story is: Emily was diagnosed with bi-lateral CDH at 6 weeks and was put in a pavlik harness for 6 weeks. Unfortunately this did not work and she was booked in for a bilateral closed reduction when she was 5 months old. Again, this was unsuccessful - but failed for a "good" reason. They could not manipulate the top of her legs into position as the cartilage had started to form the hip socket and the gap was too small for her femur to fit in. We were then told to wait until Emily was 7 months old before she had an open reduction - both legs at the same time. Our hospital is a childrens hospital and a hipbaby centre of excellence (our consultant usually performs about 4 hip baby operations each week and there is another consultant doing about the same). Their concern was with the risks of anaesthetising a small child. Apparently the risk reduces as the child gets older and from experience they are happiest to wait until that sort of age before performing open surgery. We were told that between February (when the closed reduction failed) and May (when the open reduction was performed) she could be a normal child with no braces or harness and that it wouldn't damage her hips. At that age she was never going to be likely to put any weight on her legs - but she was actively discouraged from doing so anyway - and it didn't matter if the hip socket grew in on itself any further as that was going to be trimmed away in the open reduction in any event. The operation went well and her hips were put in place properly. She had a cast change in July after 9 weeks. At that stage her nuclei were beginning to form. Her second cast change was in October 14 weeks later. By that stage the consultant was happy that the nuclei had formed properly, that the blood supply to the femurs was established and that there was no real risk of avascular necrosis. Emily has been in a cast now for a total of 7 months. She was due to have the final cast removed in January 2003, but the consultant is so pleased with her progress that he has decided to remove the cast in 2 weeks time!! So far so good...
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