Hip reconstruction surgery is successful in restoring joint congruity in patients with cerebral palsy: long-term outcome

Abstract

Early conservative treatment for hip dislocation is helpful, and operative reconstruction should also be scheduled early. Continued surveillance is necessary, and Reimers index is useful for monitoring the development of hip centering. In case of hip pain and femoral head deformity, our long-term study indicates that hip reconstruction surgery as a part of multilevel surgery improves pain and function in patients with CP and Tönnis IV hip dislocation, even if the hip joint is incongruent after operation. This incongruity improves over the long-term. If possible, a reconstruction procedure should be performed before the femoral head becomes deformed. High plasticity of the hip joint suggest that even if the femoral head is deformed, hip reconstruction can be recommended.

Hip-joint congruity after Dega osteotomy in patients with cerebral palsy: long-term results

“…[30]. The slight increase in MP in our study from post-operative to long-term examination was in line with other reports [3]. One-stage reconstruction during SEMLS seems to be the standard procedure [21].…”

“…Long-term examination showed a shift to more congruent and physiological hip-joint morphologies and a significant reduction of pain. Post-operative MP results were in line with the literature [3]. Jozwiak et al reported good results after bony reconstruction of the hip joint with pelvic osteotomy, as described by Dega.…”

“…If the MP is >60 % or a defect of the acetabular rim is present-which in most cases is laterally, superiorly and posteriorly directedbony reconstruction of the hip should be performed to reestablish good coverage and joint shape [12,31]. Salter osteotomies in cases of a high hip dislocation produced good functional results and better congruity at long-term follow up [3]. With the surveillance programmes described by Hägglund [10] and the Australian Hip Surveillance Working Group [32,33], it is possible to detect hip decentration in patients with CP very early, and situations with a high hip dislocation with destruction of the femoral head can be avoided.…”

“…The lateral capsule of the hip joint and the caput reflexum of the rectus femoris muscle causes deformity of the femoral head. Hip pain is closely associated with migration and deformity, and once the femur is deformed, the hip joint is usually painful [1].This situation deteriorates if left untreated and leads to further subluxation or dislocation, pain, loss of function and, consequently, loss of quality of life [2][3][4] . The risk increases with the loss of mobility and ability to walk, which is classified in the Gross Motor Function Classification Scale (GMFCS) [5,6].…”

“…There is evidence that the form of the femoral head and acetabulum is adjusted after a Salter procedure [3,17] but not after periacetabular osteotomies, such as the Dega osteotomy. Further investigations are needed to prove that by following this better post-operative function, the shape and form of the hip joint will adjust.…”