Elan’s hip surgery was this past Friday morning and it was a success!
Dr Shawn Standard of the Rubin Institute’s International Center for Limb Lengthening, performed the operation. The center is part of Sinai Hospital in Baltimore, Maryland.
Dr Standard is one of two Drs that has pioneered the use of the external fixator in the treatment of Perthes disease. You can find out more about Perthes here and the external fixator here.
Elan’s hip still has a round shape and that’s a good thing. We also caught this condition in the early stages, allowing for a primary vs. salvage operation. Timing is very important with Perthes. It’s bad timing that Elan is old for this condition and the extent of his involvement. It’s good timing that we’re acting before the ball begins its re-growth stage. Surgery consisted of initially drilling a tiny hole in the growth plate. They then thread a wire from the growth plate into the femoral head. They think that this helps promote blood flow back into the femoral head. Keep in mind that Perthes is caused by an interruption in blood flow to the head or ‘ball’. Perthes kids often develop a limp and the risk in drilling is that it can increase this limp (interesting sidebar: for many of us, one leg is shorter than the other. My right leg is ½” shorter than the left one. It becomes noticeable when the discrepancy is greater than 1”).
The surgeon then released the tendons or cut the groin muscles. This is done to improve Elan’s range of motion. He then shot dye into the ball and x-rayed Elan’s hip so that he could see, in real time, extent of the damage. The Dr. also put Elan’s ball back in the socket. The shape of the socket is also OK. This is important for future prognosis or an early onset of arthritis, etc. The bottom line with the ball & socket is that we want the ball as round as possible so that it fits into the socket vs. the socket having to grow around a deformed ball. The last thing the surgeon did was the biggest part of surgery- he implanted the fixator into Elan’s hip. The fixator is attached by 6 large screws and includes a bar for distraction. The fixator takes the pressure of the hip and allows Elan to be partially weight-bearing. Most important, it pulls the hip or femur bone back and allows new cartilage and ultimately bone to take shape.
The Dr is very optimistic about Elan’s chance for success. Short term success is defined as regaining range of motion and eliminating pain. Long term success is avoiding additional surgeries, the need for a new hip or ongoing pain. Each child has a different outcome so there is a fair amount of a wait and see going on. The Dr thinks that this will do it and that no further actions will be necessary. We’re still sifting through the medical information that was shared post-surgery but it looks good.
We are cautiously optimistic. This was a big deal and a very big surgery- not the kind you want to put a 9 yr old through if you don’t have to. Elan is still recovering and we are still in the hospital. We are currently working on pain management with the epidural, IV and oral meds. Elan has started physical therapy and is slowly learning to live with a fixator for the next 4 months. As some of you know and have shared with us, it is more than painful to watch helplessly as your child cries out in pain. Hopefully, the worst is behind us.
As soon as Elan is up to it, we’ll move into our new ‘home away from home’ across the street from the hospital. Jan has set up our room at the Hackerman-Patz House. This is a guest house where we will spend our time with other fixator and limb lengthening patients. In between physical therapy, I’ll also be able to get some work done! Yesterday, Jan & I distracted Elan’s bone or turned the screw in the fixator for the first time. We turn the screw 1 cm. a day for approx. 2 weeks. Then, we wait for the ball to grow into the socket.
We have started a Website to chronicle Elan’s adventure. The Website has a guestbook, daily posts by Elan and pictures. The Website doesn’t include many of the details found here and is mindful that Elan’s friends are reading and participating. Additional contact info. follows. *Please continue to email Elan and sign his guestbook. His face lights up each time he reads an email or entry.
Elan is one incredibly brave kid. His smile fades from time to time but overall is holding up well. An anisteologist told us yesterday that Elan is a model patient, has a high threshold for pain and acting three times his age. Janet & I have a new hero and his name is
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