Bilateral hip surgery in severe cerebral palsy

Owers, K. L.; Pyman, J; Gargan, Martin; Witherow, P. J.; Portinaro, Nicola

doi:10.1302/0301-620x.83b8.11266

Cited by 17 publications

(12 citation statements)

References 24 publications

(19 reference statements)

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“…Clinical assessment. The range of passive movement and fixed-flexion contractures of each hip were recorded preoperatively under general anaesthesia and were repeated at a median of three 8 and ten years post-operatively. The total range of hip movement was also assessed before surgery and three and ten years afterwards, as the sum of the differ-ence between hip flexion and fixed-flexion deformity, plus the internal rotation, external rotation and abduction and adduction of each hip recorded in flexion.…”

Section: Methodsmentioning

confidence: 99%

Bilateral hip reconstruction in severe whole-body cerebral palsy

Barakat

While

Pyman

et al. 2007

The Journal of Bone and Joint Surgery. British volume

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The results of a functional, clinical and radiological study of 30 children (60 hips) with whole-body cerebral palsy were reviewed at a mean follow-up of 10.2 years (9.5 to 11). Correction of windsweep deformity of the hips was performed by bilateral simultaneous combined soft-tissue and bony surgery at a mean age of 7.7 years (3.1 to 12.2). We were able to recall 22 patients; five had died of unrelated causes and three were lost to follow-up. Evaluation involved interviews with patients/carers and clinical and radiological examination. The gross motor functional classification system was used to assess overall motor function and showed improvement in seven patients. Of the 12 patients thought to have pain pre-operatively, only one had pain post-operatively. Improved handling was reported in 18 of 22 patients (82%). Those with handling problems were attributed by the carers to growth of the patients. All patients/carers considered the procedure worthwhile. The range of hip movements improved, and the mean windsweep index improved from 50 pre-operatively to 36 at follow-up. The migration percentage and centre-edge angle were assessed on plain radiographs. Radiological containment improved, the mean migration percentage improved from 50 pre-operatively to 20 at follow-up and the mean centre-edge angle improved from -5 degrees to 29 degrees . No statistical difference was noted between the three-year and ten-year follow-up results, indicating that the improvements in clinical and radiological outcome had been maintained.

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Section: Methodsmentioning

confidence: 99%

Bilateral hip reconstruction in severe whole-body cerebral palsy

Barakat

While

Pyman

et al. 2007

The Journal of Bone and Joint Surgery. British volume

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“…We preferred to treat the hips separately, such that in cases of bilateral dislocation, we would wait for full surgical recovery on one side before scheduling the other side. Owers et al (7) treated these hips simultaneously and with good results, although their paper did not state whether the joint capsule was opened or not, for reducing the hips.…”

Section: Discussionmentioning

confidence: 99%

“…The good results from surgical treatment for this pathological condition are very well documented in the literature. Such treatment has the aim of ensuring that the hip is in the anatomically correct position, without presenting pain, by means of proximal femoral varus osteotomy and pelvic osteotomy 5 , 6 , 7 , 8 . However, little has been written about whether the joint capsule needs to be opened in order to improve the stabilization of this hip.…”

Section: Introductionmentioning

confidence: 99%

Treatment of Paralytic Hip Dislocation Among Spastic Quadriplegic Cerebral Palsy Patients by Means of Femoral and Pelvic Osteotomy, Without Opening the Joint Capsule (Capsuloplasty)

Farcetta¹,

Abreu²,

Neves³

et al. 2010

Revista Brasileira de Ortopedia (English Edition)

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Objectives: To show the preoperative planning and results from surgical treatment for paralytic hip dislocation among patients with cerebral palsy. The techniques used were proximal femoral varus derotation osteotomy in association with Dega iliac osteotomy, without opening the joint capsule. Methods: We performed a retrospective review of ten hips in eight patients with spastic quadriplegic cerebral palsy who underwent surgical treatment between 2003 and 2005, with the same surgical technique. The pre and postoperative clinical and radiological parameters, and the preoperative planning using an image intensifier, were assessed. The clinical parameters analyzed were: pain, hygiene-related difficulties and positioning difficulties. The radiological parameters were Reimer's index, the acetabular index and the neck-shaft angle. These results were subjected to statistical analysis. Results: We obtained good results with this technique. After a mean follow-up of three years, all the hips were observed to be stable at the last assessment, and there was a high degree of satisfaction among the families in relation to the treatment. We also showed that preoperative planning using an image intensifier allowed us to reduce and stabilize these hips without the need for capsuloplasty. Conclusion: The authors conclude that in treating hip dislocation among spastic quadriplegic cerebral palsy patients, capsuloplasty is unnecessary for stabilizing the coxofemoral joint.

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“…Surgical intervention for painful fixed hip dislocation typically involves relocation of the femoral head by hip joint reconstruction. This usually involves a combination of femoral and pelvis osteotomies [4]. Proximal femoral resection is also a recognized technique for dealing with painful dislocated hips with or without an initial period of articulated hip distraction [5].…”

Section: Introductionmentioning

confidence: 99%