27257 Treatment of spontaneous hip dislocation (developmental, including congenital or pathological), by abduction, splint or traction; with manipulation, requiring anesthesia

Name of the Procedure:

Treatment of Spontaneous Hip Dislocation (Developmental, Including Congenital or Pathological), by Abduction, Splint or Traction; with Manipulation, Requiring Anesthesia

Summary

This procedure involves correcting a hip dislocation that has occurred spontaneously due to developmental, congenital, or pathological reasons. It requires repositioning the hip joint using methods such as abduction, splinting, or traction, and involves manipulation of the hip under anesthesia.

Purpose

The procedure addresses spontaneous hip dislocation, which can result from developmental abnormalities, congenital conditions, or pathological changes. The goal is to realign the hip joint to its proper position, alleviate pain, restore normal hip function, and prevent further complications.

Indications

• Developmental dysplasia of the hip (DDH)
• Congenital hip dislocation
• Pathological hip dislocation due to conditions like cerebral palsy or spina bifida
• Persistent pain and inability to bear weight on the affected hip

Preparation

• Fasting for 6-8 hours prior to the procedure if general anesthesia is used.
• Discontinuing certain medications as advised by the healthcare provider.
• Pre-procedure imaging studies such as X-rays or MRI to assess the hip joint.
• Blood tests, if required, to ensure the patient is fit for anesthesia.

Procedure Description

1. The patient is given general anesthesia to ensure they are fully unconscious and do not feel pain during the procedure.
2. The affected leg is carefully positioned into abduction.
3. A splint or traction device may be applied to maintain the position of the hip.
4. Manipulation of the hip joint is performed by the surgeon to reduce the dislocation and realign the hip.
5. Post-manipulation imaging (usually X-rays) is done to confirm the correct positioning of the hip joint.
6. A stabilizing device like a Pavlik harness or hip spica cast might be applied.

Duration

The procedure typically takes 1 to 2 hours.

Setting

The procedure is performed in a hospital or a specialized surgical center.

Personnel

• Orthopedic surgeon
• Anesthesiologist
• Surgical nurses
• Radiologist (for imaging support)

Risks and Complications

• Infection
• Bleeding
• Anesthesia-related complications
• Nerve or blood vessel injury
• Recurrence of the dislocation
• Stiffness or decreased range of motion in the hip

Benefits

• Relief from pain caused by the dislocated hip
• Improved hip stability and function
• Prevention of long-term complications such as arthritis

Recovery

• Post-procedure, the patient may need to stay in the hospital for observation.
• Pain management with medications as prescribed.
• Follow-up imaging to ensure the hip remains properly positioned.
• Physical therapy to restore strength and mobility.
• Recovery time varies; light activities may resume in a few weeks, though full recovery may take several months.

Alternatives

• Closed reduction without anesthesia in less severe cases.
• Open surgical reduction for cases where closed methods fail.
• Long-term use of orthotic devices or supportive braces.
• Each alternative comes with its own set of benefits and risks, which should be discussed with the healthcare provider.

Patient Experience

Patients will be under general anesthesia during the procedure, so they should not feel anything. After the procedure, mild to moderate discomfort is expected but can be managed with pain medications. The patient might need assistance with mobility initially and should follow all post-operative care instructions to facilitate a smooth recovery.