Varus Derotation Osteotomy

Goals: Pain management, equipment, early mobilization, discharge and transition to home

• Adjust seating as necessary to support the legs
• Teach the family transfers – sliding board, manual or mechanical lift
• Passive ROM/AAROM to joints not restricted in the cast
• Ankle plantar flexor stretches, if required
• Hip flexion should not be limited with VDRO only

Goals: Maintain joint range of motion (ROM), mobilization

• ROM – PROM/AAROM to joints not restricted in the cast
• Consider alternate positions
• Avoid windswept posturing during the healing process
• Consider lying on the stomach; required if the psoas/iliopsoas release
• Frequent position changes to prevent pressure areas
• Isometric contraction of glutei, quadriceps and hamstrings, if able

Reminder: Progression of these activities will be confirmed in the child’s post-operative appointment

Goals: Hip and knee ROM, return to pre-op function

Positioning

• The child may experience increased spasms/discomfort when the cast is removed and greater movement is allowed. Using the hip abduction splint for this transition may be helpful; e.g. you may choose to use a splint for stability during transfers
• Use a resting splint or pillow throughout the night for three months and during the day for napping and floor/sitting activities (e.g. watching television)
• Out of brace for functional mobility during the day
• Return to regular wheelchair seating with pommel

Range of motion (ROM)

• All hip ROM restrictions are removed – confirm with orthopedic team
• PROM and AAROM of all LE joints; work towards full LE ROM in all planes; do not force range
• Consider stretching the following:
  • Adductors
    • Hip in extension (i.e. supine) - with knee extension and knee flexion (frog leg position)
    • Hip in flexion - with knee extension and knee flexion
    • Ring or cross-leg sitting for play
  • Hip flexors
    • Lying on stomach
  • Hamstrings
• Scar mobility as required

Returning to activity

• Begin pool therapy program for ROM, strengthening and initiating weight-bearing – confirm weight-bearing with the orthopedic team
• Expect to progress to partial weight-bearing with a walker during this time, even if not used pre-operatively, to establish good postural habits and avoid early compensation – confirm weight-bearing with the orthopedic team

Goals: Return to full weight-bearing, return to full activity

Positioning

• You may discharge use of the night splint/pillow depending on radiological findings, tone and range of motion
• Ensure hip abduction range of motion is maintained. Consider continued use of the splint/pillow for daily stretching

Activity progression

• Initiate weight-bearing if it is not already done. Begin to ambulate with a walker even if not used pre-operatively, to establish good postural habits and avoid early compensation – confirm weight-bearing with the orthopedic team
• Evaluate the need for a shoe raise, due to shortening that occurs with femoral osteotomy (if unilateral)
• Start endurance exercises with low load and high repetition. Progress to strengthening exercises with mild resistance
• Strength training – hip abductors and extensors, and knee flexors and extensors
• Gait training
• Balance training

Goals: Pain management, equipment, early mobilization, discharge and transition to home

• Adjust seating as necessary to support the legs
• Teach the family transfers – sliding board, manual or mechanical lift
• Passive ROM/AAROM to joints not restricted in the cast
• If in a Petrie cast, you may restrict hip flexion to between 30 and 60º - confirm with orthopedic team
• Ankle plantar flexor stretches, if required

Goals: Maintain joint ROM, mobilization

• ROM – PROM/AAROM to joints not restricted in the cast
• If in a Petrie cast, you may restrict hip flexion to between 30 and 60º - confirm with orthopedic team
• Consider alternate positions
• Avoid windswept posturing during the healing process
• Consider lying on the stomach; required if the psoas/iliopsoas release
• Frequent position changes to prevent pressure areas
• Isometric contraction of glutei, quadriceps and hamstrings, if able

Reminder: Progression of these activities will be confirmed in the child’s post-operative appointment.

Goals: Hip and knee ROM, initiate weight-bearing.

Positioning

• The child may experience increased spasms/discomfort when the cast is removed and greater movement is allowed
• Using the hip abduction splint for this transition may be helpful; e.g. you may choose to use a splint for stability during transfers
• Use a resting splint or pillow throughout the night for three months and during the day for napping and floor/sitting activities (e.g. watching television)
• Out of brace for functional mobility during the day
• Return to regular wheelchair seating with pommel

Range of motion (ROM)

• All hip ROM restrictions are removed – confirm with orthopedic team
• PROM and AAROM of all LE joints; work towards full LE ROM in all planes; do not force range
• Consider stretching the following:
  • Adductors
    • Hip in extension (i.e. supine) - with knee extension and knee flexion (frog leg position)
    • Hip in flexion - with knee extension and knee flexion
    • Ring or cross-leg sitting for play
  • Hip flexors
    • Lying on stomach
  • Hamstrings
• Scar mobility as required

Returning to activity

• Begin pool therapy program for ROM, strengthening and initiation of weight-bearing – confirm weight-bearing with the orthopedic team
• Expect to progress to partial weight-bearing with walker during this time – confirm weight-bearing with the orthopedic team

Goals: Return to full weight-bearing, return to full activity

Positioning

• You may discharge use of the night splint/pillow depending on radiological findings, tone and range of motion
• Ensure hip abduction range of motion is maintained. Consider continuing using the splint/pillow for daily stretching

Activity progression

• Initiate weight-bearing if not already done – confirm weight-bearing with the orthopedic team
• Evaluate need for a shoe raise due to the shortening that occurs with femoral osteotomy (if unilateral)
• Start with endurance exercises with low load and high repetition; progress to strengthening exercises with mild resistance
• Strength training – hip abductors and extensors, and knee flexors and extensors
• Gait training
• Balance training