The hip adductor muscles on the inside of the thighs cause the legs to come together and cross over. The adductor muscles may be very tight due to spasticity. These tight muscles may contribute to hip dysplasia and may make it difficult to sit, stand and walk.
Hip dysplasia, which leads to hip dislocation, is due to the thigh bone being twisted, too straight and the ‘socket’ of the joint being too shallow. Hip adductor lengthening slows down the process of dislocation but does not correct dislocation. The procedure is performed under a general anaesthetic. The orthopaedic surgeon will surgically lengthen the muscle. This may be done with a small cut in the skin at the very top of the inner thigh or groin. The surgeon may also lengthen the muscle through the skin which may not leave an incision; however bruising may be seen some days after.
A plaster cast may be used with a rod in between the legs to keep them apart. If a plaster has not been used, it is very important to keep the legs apart after surgery to ensure that the adductor muscles heal in a lengthened position. Other options include a foam wedge with leg bands or a hip abduction brace.
Preparation for hospital
An appointment can be made by the family to see a physiotherapist to discuss how the surgery will affect day to day activities. This appointment may also be used to measure for equipment such as car seat, wheelchair, hip abduction wedge, etc.
After your child’s surgery, the main aim will be to manage pain and maintain hip alignment.
The ideal position is hips apart with knee caps pointing up to ceiling. Once the child is comfortable and only requires oral medications to sit, lie and change position with or without assistance, they are ready to go home. This is usually one to two days but may vary.
Your physiotherapist may be able to start with gentle stretching and moving in the first few weeks. They can also help with positioning and transferring child to and from the wheelchair, especially if this has been made more difficult with a large plaster cast. The physiotherapist may also make recommendations regarding standing activities.
Your child will need ongoing appointments with their surgeon to make sure the muscles have maintained their length.
Queensland Paediatric Rehabilitation Service
Queensland Children’s Hospital
Level 6, 501 Stanley Street, South Brisbane 4101
t: 07 3068 2950
t: 07 3068 1111 (general enquiries)
f: 07 3068 3909
If it’s not an emergency but you have any concerns, contact 13 Health (13 43 2584). Qualified staff will give you advice on who to talk to and how quickly you should do it. You can phone 24 hours a day, seven days a week.
In an emergency, always call 000.