Varus Derotation Osteotomy

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

• Adjust seating, as necessary, to support legs
• Family to be taught transfers – sliding board, manual, or mechanical lift
• Passive ROM /AAROM to joints not restricted in cast
• Ankle plantarflexor 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 cast
• Consider alternate positions
• Avoid windswept posturing during the healing process
• Consider lying on the stomach; required if 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

• Child may experience increased spasms/discomfort when cast removed and greater movement is allowed

Use of the hip abduction splint for this transition may be helpful e.g. may choose to use splint for stability during transfers

• Use resting splint or pillow throughout the night for three months and during the day when napping, 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 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 (ie 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 WB with orthopedic team
• Expect to progress to partial weight bearing with walker during this time, even if not used pre-operatively, to establish good postural habits, and avoid early compensation - confirm WB with orthopedic team

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

Positioning

• Use of night splint/pillow may be discharged depending upon radiological findings, tone, range of motion
• Ensure hip abduction range of motion is maintained; consider continued use of splint/pillow for daily stretching

Activity progression

• Initiate weight bearing if not already done; begin to ambulate with walker even if not used pre-operatively to establish good postural habits and avoid early compensation – confirm WB with orthopedic team
• Evaluate need for shoe raise due to shortening which occurs with femoral osteotomy (if unilateral)
• Start with endurance exercises with low load, 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 legs
• Family to be taught transfers – sliding board, manual, or mechanical lift
• Passive ROM /AAROM to joints not restricted in cast
• If in Petrie cast, hip flexion may be restricted to between 30 and 60º - confirm with orthopedic team
• Ankle plantarflexor stretches, if required

Goals: Maintain joint ROM, mobilization

• ROM – PROM/AAROM to joints not restricted in cast<
• If in Petrie cast, hip flexion may be restricted 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 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

• Child may experience increased spasms/discomfort when cast removed and greater movement is allowed
• Use of the hip abduction splint for this transition may be helpful e.g. may choose to use splint for stability during transfers
• Use resting splint or pillow throughout the night for three months and during the day when napping, 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 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 WB with orthopedic team
• Expect to progress to partial weight bearing with walker during this time – confirm WB with orthopedic team

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

Positioning

• Use of night splint/pillow may be discharged depending upon radiological findings, tone, range of motion
• Ensure hip abduction range of motion is maintained; consider continued use of splint/pillow for daily stretching

Activity progression

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