Adductor Release in Nonambulant Children with Cerebral Palsy

Silver, Ronald L.; Rang, Mercer; Chan, John; Garza, Jaime de la

doi:10.1097/01241398-198511000-00008

Cited by 101 publications

(66 citation statements)

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“…Some authors believe [9,10,14] while others do not [3,12,13], that age at time of adductor tenotomy influences the outcome. Harris et al [4] examined the acetabular remodelling in congenital dislocation of the hip and found that a significant potential for remodelling remained up to the age of 4 years.…”

Section: Discussionmentioning

confidence: 99%

Open adductor tenotomy in the prevention of hip subluxation in cerebral palsy

Pap

Kiss

Vízkelety

et al. 2004

International Orthopaedics (SICOT)

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We reviewed radiographs of 76 hips in 41 patients with cerebral palsy treated with open adductor tenotomy because of hip subluxation. The majority of patients suffered from spastic diplegia. The aim of our study was to evaluate the effect of adductor release on hip subluxation. We measured the centre-edge angle and migration percentage pre-operatively and 1 and 3 years postoperatively. We considered the results according to patients' age at time of surgery (younger or older than 4 years of age) and ability to walk. Children younger than 4 years of age had better results than children older than 4 years of age. In children without walking ability, more than half of the hips had further radiological subluxation. In children with walking ability, we observed stabilisation or improvement of femoral-head subluxation in more than three quarters of the cases.Résumé Nous avons examiné les radiographies de 76 hanches de 41 malades avec une paralysie cérébrale traitée par ténotomie à ciel ouvert des adducteurs en raison d'une subluxation de la hanche. La majorité des malades souffrait de diplégie spasmodique. Le but de notre étude était d'évaluer l'effet de la suppression des adducteurs sur la subluxation de la hanche. Nous avons mesuré l'angle de couverture externe et le pourcentage de migration avant l'intervention et à un an et trois ans post-opératoires. Nous avons considéré les résultats en fonction de l'âge des malades à la chirurgie (en dessous ou au-dessus de quatre années d'âge) et de la capacité de marche. Les enfants de moins de quatre ans avaient des meilleurs résultats que les enfants plus agés. Chez les enfants sans capacité de marche, plus de la moitié des hanches avait une plus grande subluxation radiologique. Chez les enfants avec capacité de marche, nous avons observé une stabilisation ou amélio-ration de la subluxation de la tête fémorale dans plus de trois quarts des cas.

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Section: Discussionmentioning

confidence: 99%

Open adductor tenotomy in the prevention of hip subluxation in cerebral palsy

Pap

Kiss

Vízkelety

et al. 2004

International Orthopaedics (SICOT)

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“…Several studies have shown that children operated on with unilateral soft-tissue release have a high risk of displacement of the contralateral hip [14][15][16], and these authors conclude that soft-tissue release should always be Regarding the prognosis for the contralateral hip after VOPF, the conclusions of earlier studies are inconclusive. Some authors consider that only the displaced hip should be operated on [1][2][3], while others recommend bilateral osteotomy in all cases [4][5][6].…”

Section: Discussionmentioning

confidence: 99%

Unilateral varus osteotomy of the proximal femur in children with cerebral palsy: A five-year follow-up of the development of both hips

Larsson

Hägglund

Wagner

2012

Journal of Children's Orthopaedics

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Background Varus osteotomy of the proximal femur (VOPF) is one treatment option to prevent hip dislocation in children with cerebral palsy (CP). It is questioned whether the osteotomy should be performed in the displaced hip only, or if it should be performed bilaterally to prevent later displacement of the contralateral hip. CPUP is a register and healthcare programme for children with CP that was initiated in 1994 in southern Sweden. In the programme, range-of-motion and radiographic examination of the hips is performed regularly. These data have been analysed preoperatively and for 5 years postoperatively in children treated with unilateral VOPF. Methods Children with CP living in the counties of Skåne and Blekinge in the south of Sweden, who were treated with unilateral VOPF at least 5 years ago, were included in the study. The degree of hip displacement and the range of hip motion were analysed preoperatively and after 5 years. Repeat hip operations after the index operation were recorded. Results Twenty-four children fulfilled the inclusion criteria. Mean age at index operation was 7.6 (2.8-13.2) years. No child died within 5 years postoperatively, and no child was lost from follow-up. At follow-up after 5 years, 2 of the 24 children had been operated on with VOPF in the contralateral hip. The range of motion in both hips decreased, but the difference between the index hip and the contralateral hip did not change significantly. Conclusion Children with CP and unilateral hip displacement have a low risk of later contralateral displacement after being operated on with unilateral VOPF. This supports healthcare programmes that advocate unilateral VOPF in children with unilateral hip displacement.

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“…When using the radiographic classification of Silver et al (1985) as modified by Turker and Lee (2000), 45 patients had good results ("success") and 14 had poor results ("failure"). There was a good correlation between this classification and that of Kalen and Bleck since 39 patients had good results and 12 had poor results by both classifications.…”

Section: Radiographic Outcomementioning

confidence: 99%

“…To facilitate comparison with previous studies, the radiographic results were also classified according to Silver et al (1985), as modified by Turker and Lee (2000). The result is termed poor (failure) if the hip becomes dislocated or severely subluxated (MP > 80%) during follow-up, or if a further operation is needed to improve femoral head coverage.…”

Section: Criteria For Outcomementioning

confidence: 99%

Adductor tenotomy in spastic cerebral palsy

et al. 2005

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Background There is a risk of hip dislocation in children with spastic cerebral palsy. We evaluated the prophylactic effect of adductor tenotomy in patients with long-term follow-up.Patients and methods Our material comprised 78 patients (46 boys) with a mean age of 8 (2-17) years who underwent adductor tenotomy during the period 1986-1991. 40 patients had spastic diplegia and 38 had quadriplegia. For patients who had further hip surgery, follow-up was until the next hip operation. Those who had not undergone further surgery were invited to a follow-up examination. The migration percentage (MP) was measured on the preoperative and follow-up radiographs. The radiographic result was termed good if MP at follow-up was reduced or had increased less than 10%. The follow-up period was 10 (1.6-16) years, with a mean of 6 years for patients with later hip surgery and 13 years without such surgery.Results The clinical outcome was good in 51 cases, poor in 12, and uncertain in 15. The radiographic result was good in 39 of the 53 patients with radiographs available both preoperatively and at follow-up. The patients with good radiographic results had lower preoperative MP than those with poor results (MP 34% versus 49%) and lower preoperative acetabular index. The mean increase in MP (worst hip in each patient) was 1.9% per year, which is considerably less than that in nonoperated patients. Further hip surgery was necessary in 27 patients, because of increasing MP in 14 cases and for clinical reasons in 13. Interpretation Adductor tenotomy reduced the trend towards lateral displacement of the hip joints. The operation had a favorable outcome in approximately

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Adductor Release in Nonambulant Children with Cerebral Palsy

Cited by 101 publications

References 0 publications

Open adductor tenotomy in the prevention of hip subluxation in cerebral palsy

Open adductor tenotomy in the prevention of hip subluxation in cerebral palsy

Unilateral varus osteotomy of the proximal femur in children with cerebral palsy: A five-year follow-up of the development of both hips

Adductor tenotomy in spastic cerebral palsy

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