Clinical and radiological outcome of combined femoral and Chiari osteotomies for subluxed or dislocated hips secondary to neuromuscular conditions: a minimum of 10-year follow-up

Abstract

We evaluated the medium-term results of combined Chiari pelvic and femoral osteotomies performed at the Manchester Children's Hospitals between the years 1985 and 1994. The indications for these osteotomies were either hip dislocation or subluxation in children with neuromuscular disease. We clinically and radiologically evaluated 20 hips in 18 patients treated for hip subluxation and dislocation with Chiari osteotomy. The average post-operative clinical follow-up period was 11.32 years (range 10.1-12.9). The mean age at the time of surgery was 7.3 years (range 3.1-13.2 years). Clinically, 9 hips had a 'Good' outcome, 10 were "Fair" and 1 was "Poor" according to Osterkamp criteria. At last follow-up, radiologically the mean Sharp's angle improved from 51° to 44° (p = 0.09), the mean Centre-Edge angle improved from -16° to 18° (p = 0.067), the mean Migration Index improved from 59 to 29 % (p = 0.011), the mean femoral neck-shaft angle from 160° to 117° (p < 0.0001) and the Severin criteria improved from an average grade of 4.5-2.9 (p < 0.0001). Our results compared to previous studies confirm that combined femoral and Chiari osteotomies provide a favourable outcome both clinically and radiologically at least 10 years following surgery. Accepting that the numbers are small, we report no statistical difference in the mean age at the time of operation when comparing the children with an eventual 'good' outcome and those with an eventual 'fair' or 'poor' outcome.

Radiological outcome of reconstructive hip surgery in children with gross motor function classification system IV and V cerebral palsy

“…Good concordance has been suggested between radiological and clinical outcomes in this patient population [18], but further studies are needed. The first is that we examined only the radiological outcome and did not address functional outcomes.…”

Desenlaces clínicos y radiológicos del tratamiento quirúrgico de la cadera paralítica en pacientes con parálisis cerebral en Bogotá, Colombia

“…15,22 En cuanto a los desenlaces radiográficos evaluados, la comparación de las medidas pre y posoperatorias demostraron la corrección de la deformidad, hallazgo que es consistente con los reportado en estudios donde se evidenció la corrección de la LPC mediante la normalización del porcentaje de migración de Reimers y la horizontalización del ángulo de Pauwels. 23,24,25 Por último, en este estudio las complicaciones posoperatorias incluyeron un caso de infección del sitio operatorio y uno de fractura, además de 8 pacientes con reluxación, lo cual es similar a lo descrito en otros estudios. 26,27,28 La principal limitación del presente estudio es la imposibilidad de extrapolar los resultados a otros contextos, ya que la institución donde se realizó la investigación es un centro de referencia y, por lo tanto, atiende pacientes con casos complejos de PC y LPC que no necesariamente reflejan el comportamiento de la población colombiana en general.…”

Chiari pelvic osteotomy in treatment of hip dysplasia

“…Кја ри је ва осте о то ми ја се пре вас ход но при ме њу је код бо ле сни ка с не до вољ но раз ви је ним аце та бу лу мом као по сле ди цом раз вој ног по ре ме ћа ја ку ка. Ова ме то да се јед на ко успе шно при ме њу је у свим пре о ста лим слу ча је ви ма не до вољ не нат кро вље но сти гла ве бут не ко сти (по стре дук ци о на ис хе миј ска не кро за, Mor bus Pert hes), као и код па ра ли тич ке дис ло ка ци је ку ка у скло пу це ре брал не па ра ли зе [19,20].…”