The hip distractor is a device which is
used to treat collapse or stiffness of the hip joint, by relieving
the weight bearing stress. The hip joint is a ball and socket type
joint, formed by the round head of femur with the
cup shaped acetabulum in the pelvis. Movement of
the hip is multi-directional - up, down, side to side as well as
inward and outward rotation.
Figure 1
The distractor is fixed above by pins
to the pelvis, and below by pins to the femur.
Figure 2
It is hinged to permit only one
direction of movement - up and down. No sideways or rotational
movement of the thigh is possible. The distractor may be in place
for around 3-6 months. During this time the child is encouraged to
walk with a walking frame or crutches, generally putting some
weight through the leg. (This must be confirmed by the Orthopaedic
Surgeon.) Vigorous activity eg. strenuous walking, running and
climbing, should be avoided. From the first days after surgery,
exercise and correct positioning are very important to avoid joint
and muscle tightness. The physiotherapist will show your child
exercises to do in hospital and for when you go home.
Night positioning/positioning in
bed
In bed, the knee should generally be
positioned fully straight. This is usually achieved by the
placement of pillows to avoid knee bending.
Figure 3
As soon as possible after surgery, the
child should lie on his/her tummy 1-2 hours per day. This stretches
the muscle across the front of the hip.
Figure 4
Exercises
To be practised at least 3 times
daily.
1. Hip knee bends:
Slide the heel up the bed and down. Assist the child as necessary X
10.
Figure 5
2. Static quads:
Tighten the muscle on top of thigh. Push the back of your knee down
to bed. Hold for 3 seconds x 10.
Figure 6
3. Quads over roll:
With knee over roll, straighten knee by tightening muscle on top of
thigh. Make sure the knee stays on the roll. Hold for 3 seconds x
10.
Figure 7
4. Static glutes:
Squeeze "bottom" muscles together. Hold for 3 seconds x 10.
Figure 8
5. Hip flexor stretch:
Bring right/left knee to chest and hold. While keeping lower back
flat against the bed, lower right/left leg flat down to the bed -
stretch should be felt across front of the hip. Hold for 30 seconds
x 2.
Figure 9
6. Foot up/down: x
10.
Figure 10
7. Foot circles: x
10.
Figure 11