Untitled

Abstract

We reviewed 39 children with cerebral palsy who had surgery for hip subluxation or dislocation. Of 55 treated hips, 31 had a varus derotation osteotomy alone, and 24 had a combination of varus derotation osteotomy and an acetabular procedure. There was no significant difference in the ages of the two groups. There was no difference in the preoperative acetabular indices of the two groups, but the average percentage of preoperative uncoverage of the femoral head was 56% in the group with varus derotation osteotomy and 63% in the group with combined varus derotation osteotomy with an acetabular procedure. The incidence of resubluxation or redislocation (24%) after varus derotation osteotomy alone was higher than that after varus derotation osteotomy with an acetabular procedure (13%). The incidence of postoperative hip instability was higher in the patients who had preoperative uncoverage of the femoral head ranging from 70 to 100%. This was in comparison with the patients who had preoperative uncoverage of the femoral head ranging from 30 to 70%. These results suggest that a combination of varus derotation osteotomy and an acetabular procedure decreases the incidence of resubluxation or redislocation, and that unstable hips with > 70% uncoverage of the femoral head should undergo the combined procedure.

Avascular necrosis in children with cerebral palsy after reconstructive hip surgery

“…The reported incidence of AVN of the femoral head in children with CP after hip reconstruction is in the range of 0% to 69%. 10 , 11 , 13 , 18 , 20 , 28 - 30 A recent systematic review 31 on the subject revealed that most authors simply comment on the presence or absence of AVN in their complications, without further detail. Interestingly, the reported rates in our study as well as three others where AVN was the primary outcome measure are among the highest within the literature at 27% to 69%.…”

“…The incidence of AVN reported within the literature is in the range of 0% to 69%. 10 , 11 , 14 , 15 , 17 - 20 This variation has made it difficult to quantify and determine the true impact of AVN on children with CP. Idiopathic AVN has been reported to cause pain, limited range of motion (ROM) and an altered gait pattern.…”

Proximal femoral excision with interposition myoplasty for cerebral palsy patients with painful chronic hip dislocation

“…Prevention of hip dislocation is important during childhood and a screening programme with early intervention can be effective [ 1 ]. This includes soft tissue release such as adductor tenotomies [ 20 , 21 ] and femoral/pelvic osteotomies in young patients with an open triradiate cartilage and without secondary degenerative change [ 14 , 15 , 22 , 23 ]. Patients with a chronic hip dislocation can be free of pain and functional problems but with the onset of degenerative change when there may be erosion of the femoral head, pain tends to become a significant issue provoking spasm and exacerbating existing joint stiffness and contracture.…”

Early Results of One-Stage Correction for Hip Instability in Cerebral Palsy

“…Therefore, many authors believe the migration percentage is the most accurate way to monitor hip instability in such patients. It has been recommended that acetabular correction should be performed when the migration percentage is over 50-70%, because the more serious the dislocation of the femoral head, the more likely it is accompanied by acetabular deficiency 19,20). To compare the changes in the acetabulum before and after surgery, we used the coronal image of CT in the measurement of acetabular indices in cases where this had not been taken in the correct position.…”