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• The pre-operative discussion
• Hip surgery
• Explaining surgery to parents

The pre-operative discussion

There are three issues in a pre-operative discussion. The first issue is just making sure that all the other associated medical problems that these kids have are dealt with because it’s often not the orthopedic surgery that keeps the kids in the hospital that complicates the surgery. It’s often that their associated with medical conditions, such as seizure disorders, problems with reflux or constipation basically just come back and bite you during a postoperative period. So first it’s addressing those issues upfront to try to minimize the problems post surgery. Second, is then a clear discussion is to exactly what the surgery is. What it entails and what the incisions will look like. The third part is a discussion as to what the rehabilitation and post-operative period will consist of. My statement is always that the surgery is easiest part of the whole protocol. It’s the post-operative recovery with rehabilitation that’s the hardest and the most important.  If children and families cannot partake in a physical therapy program after the surgery, the surgery itself is pretty much useless. So the hard work is the rehab afterwards. And that is explaining to parents that this will take months. It will take three months before the kid is even remotely back to the level that they were before the surgery. Six months before maybe they see some improvement. Really, truly close to a year before you can actually assess whether the surgery was helpful or not. 

-Brian Snyder, MD, PhD, Orthopedic Surgeon, Cerebral Palsy Program

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Hip surgery

We have a fairly standard post-operative follow-up routine for hip surgery. From the day of surgery, a post-operative visit happens about three weeks after and your child will get x-rays of the hips if he or she had bony work done. If there was no bony work done, there are no x-rays and the visit is mainly for wound evaluation and then if everything else is going well, he or she will be allowed to do just gentle range of motion on the hips, knees, and ankles.  The child will stay in the braces that he or she came out of the surgery in.  After three weeks, he or she is allowed to come out of it for bathing and physical therapy, otherwise the child needs to stay in them for another 3 weeks. Then when you come back for the 6 week follow-up visit, he or she gets rid of the braces entirely or stays in them at night at least, depending on what the individual situation is.

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Explaining surgery to parents

Pre-operatively for each operation, I pull up the x-ray on the computer screen and I try to illustrate a little bit of what’s going to be done. The verbal medium probably isn’t the best at illustrating to parents what I’m doing with the surgery and what my result is. But I would say in the generic sense, we will never do an operation that at the end of the day where I cannot rationalize an improvement in function and quality of life. If I’m doing something where the kid just looks different, but it’s not going to change anything. In those cases, I won’t do those procedures because I just don’t see a purpose to them. I try to illustrate to the parents sort of exactly what bones will be done. What bones I’m moving, where the cuts are going to be, and what plates are going to be used, and I think that’s really hard to do on a website. That’s one of the problems with the internet. Parents take specific cases of their child and what was done and potentially complications or successes happen. Then other parents, not understanding some of the subtleties will say, “Well, my child’s having a hip operation” and can’t appreciate the differences either in the purpose of the surgery or the technique of the surgery or the rehab program afterwards. Parents look up on websites, for example, and see after hip surgery, kids are in a body cast for three months. But we don’t do that. We put kids in two long leg casts for three weeks and after three weeks, I let them get into the swimming pool. That’s sort of one of the problems with talking about how you approach a surgery in a generic sense. A parent then looking at that to extrapolate to their child and there is misapplication of information.

-Brian Snyder, MD, PhD, Orthopedic Surgeon, Cerebral Palsy Program

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