What exactly are they doing to Jack

I don't know if I ever covered exactly what they are doing during Jack's operation.  The procedure is called a femoral osteotomy, but what exactly does that mean?

Since the right femur was not in place as Jack was developing in the womb his his socket did not develop as it should.  When he was 9 months old the doctor did an open reduction where the leg and hip were lined up and a cast was put on to hold them in a specific position.  Over the next few years he was watched for continued hip growth; the hope being that now that the hip a femur were lined up properly they hip socket and head of the femur would play catch up and develop properly.  Unfortunately the hip socket is still a bit too shallow and the femur is growing past the angle it should be at.  The femoral osteotomy will basically cut the head of the femur off, cut a wedge out of the bone and reposition the head of the femur in a postilion that, as he grows, will shape into how it should be.  The doctor will them put a plate a screws in to hold the femur head in position as the bone heals.  These will stay in place for about 12 - 18 months when he will need a second surgery to remove them.

"Normally due to the plate and pins, an external body cast is not necessary and the patient will spend several weeks post-surgery using crutches and several months in physical therapy to strengthen the hip and leg muscles." However since Jack is too young for crutches and to be kept off the leg he will need a cast.  As for physical therapy, I am pushing the doctor to recommend it, but it kind of goes back to an old disagreement we have on whether or not Jack needs PT and if his weak core muscles are due to hip dysplasia.

From a medical website:

Once postoperative swelling has diminished, the patient will be aware of the plate to a varying degree, depending on individual sensitivity and physical size. Awareness and daily discomfort are the major factors that contribute to the decision to undergo a second surgery to remove the hardware. In any event, the plate must stay in place for 12 months to give the bone sufficient opportunity to heal.


The second surgery is relatively simple: The surgeon goes in about halfway along the initial incision and removes the plate and pins. The largest hole created by the top of the metal pin in the femoral head is filled with synthetic bone filler, and the lower holes fill in on their own, requiring another, shorter period of time on crutches post-surgery. Overall, however, this surgery requires far less hospital time and physical therapy than other surgeries.


Major complications include infection, neurovascular injury, nonunion of bone, inability to obtain or maintain a full correction, postoperative pain and continued degeneration of cartilage. Other complications include deep vein thrombosis and painful hardware. However, the likelihood of any of these complications is roughly 1 percent.


Overall, hip range of motion, gait, pain, leg-length discrepancy and patient satisfaction are improved from femoral osteotomy, and a successful surgery may reduce or even entirely remove the need for a total hip replacement during the patient's lifetime.