Using Traction to Treat Hip Dysplasia (DDH)

When I first heard that traction was an option for my daughter to treat her dislocated left hip, I was immediately turned off. The thought screamed archaic, cruel, and unusual punishment to me, and I wanted nothing to do with it. However, since it was recommended by Dr. Perry Schoenecker from Shriner’s Hospital in St. Louis (one of the premier DDH surgeons in the world) I wanted to make sure I gave it proper consideration. So, I sent out an email to the hipbaby yahoo group and was surprised by the positive responses. Most people whose children had been through traction were pleased with the process and said it was not nearly as bad as they thought it would be. But there wasn’t much information out there because it isn’t that common anymore.

Using traction to treat hip dysplasia

Best I can tell, traction fell out of popularity in our insurance driven world because it is expensive – not only monetarily (most insurance companies won’t pay for it so most hospitals don’t even offer it as an option), but also in terms of sheer time. Shriner’s and Scottish Rite Hospitals are two of the only hospitals in the US to offer it because insurance has no say on how they administer patient care. (But I’m not writing this to get into my hate-hate relationship with the state of health insurance in the US, so I’ll stop talking about it now.)

Time is another huge factor when it comes to traction. Had we gone the traction route, we would have spent ten entire days in the hospital before surgery. Any way you look at, that’s hard on a family – especially for us with three other (home-schooled) children to think about. It was a really hard decision for us, but in the end, we opted to stay put and have Sara’s surgery closer to home at the University of Iowa with another premier DDH surgeon (Dr. Stewart Weinstein) who does not use traction and has not since the 1970s. I consider myself so lucky to have had to make a decision between the two men we visited. Both are top-notch in their field and I’m happy we met them both.

Using traction to treat hip dysplasia

When I heard about another mom whose daughter went through traction in England, I asked if she would be willing to share details on my blog, and she happily obliged! I’m so honored to share her story and I hope it helps other people out there who are caught up in the DDH nightmare and trying to figure out what to do.

If you are an American reader – here is a glossary that might help:

nappie – diaper
vest – onesie
cot – crib
Here’s Roberta’s story:

Treatment for hip dysplasia seems to vary a lot across hospitals and consultants. Our 19 month old daughter Roberta had an open reduction and acetabuloplasty (slight hip joint reshape) for her dislocated hip in Southampton in the UK – but to help her prepare for this she spent a week in traction before her surgery. Because this seems to be fairly unusual for open reductions, Michelle asked me to write a little about it for her blog.

Why traction?
Traction is sometimes used before an attempted closed reduction to loosen the ligaments and increase the chances of success. However, our consultant was always planning for an open reduction and acetabuloplasty for Roberta as her x-ray showed a high dislocation and the hip had been out of joint for a long time.

My understanding is that the traction helps the joint prepare for an open reduction because it helps stretch the blood supply around the top of the femur, so it can travel with the top of the femur into the hip socket. While this doesn’t make for less invasive surgery, it is thought to reduce the chance of the blood supply to the joint being compromised, and support hip growth during recovery from surgery and beyond.

How the traction worked
Roberta spent her week in ‘Gallows traction’ with her feet suspended from a bar above her cot, so that her bottom was raised from the mattress. She had to stay in this position for a week without a break – so she ate, slept and played like this. She could spin around though, and amazed us with her cot climbing, head spinning break-dancing routines. Amazingly, she was mostly happy through this – sleeping better than at home (we wondered if her hip was more comfortable) and enjoying all the attention from other patients and the nurses.

Preparing for the treatment
As Roberta was going straight from traction to surgery, and she would be spending a total of about 10 days in hospital (7 in traction, followed by surgery and recovery) we had a lot to pack and prepare for. Specifically for the traction part of our trip, we packed:

– Vests and socks (her legs were bandaged throughout – but the socks were handy at night when her feet got a little cooler)
– Toys that she could play with on her back, and lots of books. We took lots of instruments and small electronic toys, but also some quiet toys for when it wasn’t appropriate for her to be noisy (when others in neighbouring beds were just back from surgery or were sleeping, etc)
– A helium balloon (my mum actually bought this for her during our stay – but it was invaluable, she loved it)
– Snacks for her and for me – I probably overdid this as I was worried she would only be able to eat finger food. In fact she also ate the hospital food very well from a spoon so we didn’t need nearly as much as I had packed.
– Her sippy cup. Roberta was breastfed and wouldn’t drink from a bottle or valved cup. I was worried about this because of the need for her to drink lying down – and spent ages pre hospital trying to get her to drink from cups with valves, to no avail. I needn’t have worried – she drank from her normal sippy cup no problem.
– Nappies (her usual size) and wipes
– Her toothbrush and toothpaste, cotton wool and a pot for water, so I could wash her in her cot.

Cuddles, co-sleeping, and breastfeeding
I had been worried Roberta would be very unhappy in traction as she loves her cuddles – we had been co-sleeping, and while I had spent the month prior to going to hospital getting her used to being in her cot so it all wasn’t a shock at once, I thought she would still hate being tied up in a cot and unable to have decent cuddles. However, it turned out this fear too was unfounded. In hospital the cot bars came right down so I could cuddle her easily. I was also sleeping right next to her in a fold down bed, and the bars were wide enough that I could get my arm through to hug her while we were both drifting off. I would even have been able to continue breastfeeding her in the cot – though as it turns out the combination of her being in traction, and the necessary slightly awkward positioning seemed to be enough to make her just laugh at me for trying, so at 19 months she chose her stay in hospital to finish self weaning (we had been doing an evening feed only up to that point).

In summary…
All in all the traction went very smoothly and Roberta adapted to it very well. She was quite cross about it for the first 2 hours, but once she got used to it I think she almost enjoyed it and felt more comfortable. I had been worried she wouldn’t sleep or eat – and would go in to surgery quite weakened, but this really wasn’t the case. Roberta is now recovering well from her operation and getting used to life in a cast. She will have 3 months in casts in total, followed by six weeks in a night brace – and then will be followed up until she has finished growing to check whether further surgery is needed.

Thanks so much, Elinor, for this helpful information! For more posts on our experience with DDH, you can read here.

If you’ve been through traction, or are considering it, I’d love to hear from you! Please leave a comment.

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Comments

  1. Such an informative piece. It still amazes how the treatment varies so so much from hopsital to hospital. Lets hope all our littles are soon up on their feet. x
    • Thanks Emma :-) We've been enrolled by the hospital into an ihdi study looking at outcomes for different techniques used in different centres (data collection only, it doesn't affect our treatment). Hopefully that study will start to inform some guidance / consistency once published - fingers crossed anyway!

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