Femoral osteotomy: patient/carer information

We understand that your child’s operation can be a very stressful experience for you. In keeping with our Mission to offer compassionate, quality care, this booklet aims to alleviate some of your concerns. It explains the general day-to-day events that may occur during your child’s visit and what to expect when they are discharged from hospital.

It is, however, only a general guideline as your child’s treatment will need to be tailored in accordance to their individual needs.

If you have any questions about your child’s treatment please ask the doctor or nurse.

Our pastoral care team offers a caring support network to all patients. The dedicated members of this team will visit you and your child during their stay and are available at your request to discuss any anxieties or problems that you may have.

What to expect from your child prior to discharge

At the time of discharge, your child should be slowly moving about with assistance, eating and drinking, and able to carry out a few everyday activities with good control of pain and muscle spasm.

Your child’s wound should be healing with no problems.

If your child had additional health care needs prior to surgery, they should be as they were before surgery.

We aim to support parents to feel confident and able to manage their child at home with education, support and any equipment needed for ongoing care at home.

Femoral osteotomy

Your child’s doctor has recommended that your child needs a femoral osteotomy because the top (or head) of their thighbone (femur) needs to be repositioned in the cup shaped socket of the pelvis.

This involves an operation, which is performed by an orthopaedic surgical team.

Osteotomy refers to a cut in the bone. A femoral osteotomy is a cut in the bone to angle the upper femur into the hip socket. The cut is below the neck of the femur.

During the operation, metal ware (metal plate, nails and/or screws), as illustrated in the diagram below, is placed in the bone and your child may be placed in a hip spica cast.

The goal of a femoral osteotomy is to position the femoral head in the pelvic socket. The femoral osteotomy operation aims to correct the deformity, improve mobilisation and/or position, and improve your child’s comfort.

Because your child’s health is important to us, please notify the Mater Children’s Hospitals prior to admission, if your child:

is unwell
has an ear infection
has a cough or cold
is vomiting or has diarrhoea
has a fever
has had contact with any infectious illnesses (such as chickenpox)
has any scratches or broken skin on the leg/hip on the operative side.

Your child’s operation may be postponed if they have any of the above conditions.

To contact the Mater Children’s Hospital Specialist Clinic’s please telephone 07 3163 8189 (Monday to Friday, from 8.30 am to 5 pm). Alternatively, please telephone 07 3163 8111 and ask the hospital switchboard operator to page the nurse manager for Mater Children’s Hospital.

Admission to hospital/day of surgery

What to bring:

pyjamas, clothes
toiletries, including toothbrush, toothpaste, hairbrush
comforters (eg blankets, teddy bears, pillow)
your child's regular medications
relevant medical information
nappies/incontinence pads as required by your child
special dietary requirements
your child's formula and any special bottles, teats, cups or spoons that your child uses
feeding equipment and feeding device connectors.

On admission, the staff will show you to your child's room. The admitting nurse will introduce themself and describe the ward and the facilities.

If you wish to remain with your child, one parent/carer may stay overnight. A fold out bed or recliner chair can be provided. Please discuss this with your child’s nurse.

The nurse will apply an identification band to your child’s wrist or ankle. This needs to stay on while your child is in hospital for safety reasons. If the band comes off, please notify nursing staff, as it will need to be replaced.

The nurse will record your child’s weight, temperature, pulse, and respiratory rate and enquire about your child’s medical/surgical history. The nurse will also ask if your child has any other health care needs while they are in hospital. This information is important in planning your child’s care and ensuring they will be given the best care for their needs.

If your child has other health care needs, a paediatrician may also see them during their hospital stay.

You need to tell the nurse if your child has any allergies to medicine, food, tapes or latex.

Your child can expect to stay in hospital for five to seven days or until they have met the expected recovery outcomes. These outcomes are found on the front page of your child’s carepath. Please ask your child’s nurse to discuss these with you.

Please bring a list of all the medicines your child is taking, including herbal and homeopathic tonics. Some medicines are important to continue taking and some medicines may need to be stopped before surgery because they may affect your child’s progress while in hospital.

An anaesthetist will see your child before surgery. This may happen in the pre-admission clinic or in hospital.

The anaesthetist will discuss:

the best way of beginning the anaesthetic including whether any sedation will be needed before going to theatre and whether it would be helpful for you to stay with your child as the anaesthetic begins
the best form of pain control (intravenous, epidural, patient controlled or nurse controlled analgesia, oral, or suppository)
the way the Pain Management Service will work
what happens if your child is feeling sick or vomiting after the operation
previous experiences with anaesthesia and surgery
medicines that your child is currently taking.

The nurse will talk to you about pain rating scales that are used after the operation. Pain rating scales will help find out how well the pain medicine is working. The nurse will also ask you how your child shows pain.

As a parent/carer, you will be involved in helping the doctors and nurses understand your child’s pain. This will help us to help your child to be as comfortable as possible after the operation.

Your child’s doctor may also see you and your child before the operation.

Your child may need a shower or bath with an antibacterial wash before their operation to help remove germs on their skin. If your child is allergic to iodine or soap, please inform the nurse. For safety reasons, please remove any nail polish, earrings and/or hair bands with metal in them before your child’s operation.

Your child will be fasting before the operation and they cannot have anything to drink or eat (including chewing gum and lollies). Please refer to the Fasting instructions brochure. Your child is able to brush their teeth, but not swallow the water.

We understand that this may be a very difficult time for your child and your family. Please discuss any concerns you may have with the nurse. We aim to make the following days as comfortable as we are able for you and your child.

If you do not understand any of this information, please inform the nurse who will be able to assist you.

When it is time for your child’s operation, you and your child are accompanied to the operating room on level 5. Your child will be in either a bed or wheelchair.

In the theatre reception, a theatre nurse will greet your child, check their identification band and ask any necessary questions about your child. This area can often be cooler than the ward. If your child needs a warm blanket, just ask.

Generally, one parent/carer can stay with your child until they fall asleep.

While your child is in surgery, you may like to wait in the parents’ lounge. Please inform the nurse where you will be, as your child’s surgeon will need to speak with you after the operation (which generally takes about two to three hours).

After the operation, your child will be transferred to the recovery unit. A recovery unit nurse will call you when it is possible to see your child. Both parents/carers can be in the recovery unit.

Your presence when your child wakes up in the recovery unit is important because they will be looking for a familiar face. It can be distressing to see your child waking up from an anaesthetic—they may be sleepy, crying or be quietly awake. Often children will begin to cry when they see you.

The recovery nurse will discuss any instructions from the surgeon with the ward nurse. Your child will be transferred on the bed to their room, with a nurse and a wards person.

After the operation, your child will have fluids and pain medicine as discussed with the anaesthetist before the surgery. Your child may have a hip spica cast, a dressing over the wound, and possibly a urinary catheter.

The nurse will make a full assessment of your child and record their temperature, heart rate, respiratory rate, and blood pressure. They will also check your child’s medicines, hip spica cast, dressing and any tubes/fluids. They will also assess their toes for circulation and assess your child’s position and level of comfort. The doctors and nurses will touch your child’s feet and toes and ask if they has any numbness, sleepy sensations, or tingling feelings.

Post-operative phase

It is routine that the nurse will assess your child frequently after the operation. This is so important to your child’s progress and they will be woken through the night to do so.

A daily review by the team of doctors that operated on your child will occur. If you have any concerns about your child, please speak with your child’s nurse or doctor.

When your child is fully awake after the surgery, they are able to have clear drinks (ice chips, water and ice blocks). Your child’s normal diet may commence gradually when they are tolerating fluids. Your child will have IV therapy for three to four days after the operation. This may be longer if they are unable to tolerate diet and fluids.

Please ask the nurse before giving your child anything to drink or eat. The nurse will be recording the amounts that your child is drinking and eating.

It is important that your child’s pain is controlled and that they are comfortable. The best form of pain control for your child will be part of the discussion with the anaesthetist before their operation. Your child will have stronger pain medicine in the first two to four days after the operation.

Other pain relieving medicines may be given orally or as a suppository. The Pain Management Service will be monitoring your child’s progress after the operation and the nurse will be assessing your child’s comfort and pain.

It is very important to help the nursing staff understand when your child is experiencing pain. Your child may suddenly cry or scream, or be upset. If this happens, they may be experiencing muscle spasms. This is very difficult to treat, however, will pass with time. Please tell the nurse if this happens so that your child’s needs may be tended to.

Your child may be feeling sick or vomiting after the anaesthetic. This may last for the first few days after the operation. The nurse needs to know if your child is feeling sick or vomiting, so that medicine may be administered to your child.

Some children may have an epidural for approximately three days. The urinary catheter will stay in as long as they have the epidural. Nursing staff will take the catheter out after the epidural is finished.

You can expect to see some swelling and bruising in the genital area. This is because it is close to the operated area.

For children in hip spica casts, nappies and/or a sanitary pad are used to absorb the urine. The nurse will show you how to put nappies and/or a sanitary pad on your child.

During the operation, the cut made through the skin and bone will be closed with stitches. These stiches are dissolvable and will be absorbed by the skin.

A dressing is placed over the wound, and stays on while your child is in the hip spica cast. If your child does not need the hip spica cast, the dressing should be removed after a couple of weeks.

A waterproof tape may be applied around the edges of the cast. This protects the cast from absorbing urine and/or moisture. Tape will be applied in either the operating room or when your child returns to the ward.

A nurse will record the amount of urine that your child passes, including when they have a wet nappy. The nurse will also record when your child has a bowel motion. After surgery, some pain-relieving medicines may cause constipation. It is important to discuss your child’s usual bowel medicines and routine with the nurse before the operation to help avoid bowel-related problems after the operation.

The physiotherapist will be involved in the care of your child. Treatment will commence the day after surgery for movement and/or positioning.

Your child should be able to lie on their back and side-to-side in the first couple of days. After this time, they may be turned onto their stomach. The nursing staff will turn your child every two to four hours.

Because a lot of children requiring a femoral osteotomy will be in a hip spica cast, the nurse will show you how to turn and move your child safely. Your child should not sit up more than 45° or be carried without support of the hip spica cast.

The Hip spica cast care book is available for you.

Your child will have a sponge bath every day, and other daily care routines will continue.

During your child’s stay, our valuable volunteers, including pastoral care, Captain Starlight, and Radio Lollipop, may visit. Please inform your child’s nurse if you prefer they didn’t visit.

As a parent/carer, you can expect to feel tired in the days following your child’s operation. You may also feel anxious and stressed. If you would like to take time out but prefer not to leave your child, we are able to organise for a volunteer carer to stay with your child.

You are essential in helping us care for your child and we would like to offer you as much support as we can. Please ask our staff any questions that you may have as soon as they come to mind.

Discharge phase

Your child will be ready to go home when the doctor treating your child considers them ready for discharge and when they:

are moving with support
are tolerating food and fluids
are able to rolerate a reduced level of everyday activities
have effective control of pain and muscle spasm with oral analgesia (medicine)
have wound healing without complications.

What you may require for discharge

community nurses/therapists
care supports organised
transport (Queensland Ambulance Service)
seatbelt exemption form
reclining wheelchair or other physiotherapy recommended equipment
slipper pans
urinals
nappies
crutches
medicines
Hip spica cast care brochure
mobility instructions from your child's surgeon

Your child may return home ina hip spica, which will stay in place for six weeks. After this time, your child will return to the hospital for its removal.

After femoral osteotomy, bone healing will take about 10–12 weeks. For most of this time, your child's mobility will be limited. This is because of the hip spica cast and rehabilitation.

Your child will have an appointment approximately six weeks after their discharge from hospital. It is very important for your child's progress that they return for scheduled appointments.

Things to discuss with your child’s nurse

your plans for staying with your child while they are in hospital
your child’s medical condition/s, as well as any previous operations that they’ve had
the expected recovery outcomes for femoral osteotomy
your child’s regular medicines, including herbal or homeopathic tonics
any allergies or reactions to medicines, tapes or foods
what nursing staff need to know to make your child as comfortable as possible
fasting instructions before the operation
your child’s experience of pain
if your child has a bowel routine
Hip spica cast care booklet
if you’d like your child to have visits by hospital volunteers
visitation forms
if your child has complex special needs.

Never cut the cast, or break edges off the cast. Broken or rough cast edges may cause skin irritation and/or pressure areas if left to rub against the skin. The purpose of the cast is to reduce the movement in their hip/s and leg/s following the surgery.

Seek medical help immediately if

your child’s toes become pale or blue, feel cold when you touch them, are numb or tingling, or become swollen (and do not return to normal after resting them on a pillow)
your child is unable to wiggle or move their toes
the cast becomes loose or tight (you should be able to fit a finger between the cast and your child’s skin)
any objects are stuck inside the cast
you feel oozing under the cast
the cast feels damp, wet, soft, is cracked, or an unpleasant odour is coming from the cast
your child feels a rubbing or burning sensation under the cast
your child’s skin becomes red, irritated or there are broken areas or blisters under the edges of the cast
your child has a fever
your child experiences discomfort or pain not eased with either pain medicine and/or changes in their position (such as placing a pillow under their knee).

If you have any questions or concerns about your child’s progress, please contact the Mater Children’s Hospital Emergency Department on 07 3163 2400 or your child’s GP immediately.

If you have an urgent question please telephone Mater Health Services on 07 3163 8111 and ask to speak with the orthopaedic registrar on call.

References

Hip Spica Cast Care, Cincinnati Children’s Hospital Medical Center
www.cincinnatichildrens.org/health/info/orthopaedics/home

Hip Spica Cast: A Guide for Parents
www.uihealthcare.com/topics/medicaldepartments/pediatrics/hipspica/index.html

How to Care for Your Child in a Hip Spica, Mater Children’s Hospital Brisbane Revised: January 2004

Developmental Dysplasia of the Hip, Children, Youth and Women’s Health Service
www.cyh.com/HealthTopics

Perthes Disease, Royal Children’s Hospital—Education Institute
www.rch.org.au

For more information about Mater Children’s Hospitals telephone Reception on 07 3163 8111.

Acknowledgments: Staff of Mater Children’s Hospitals

Menu