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

Abstract

Subluxation and dislocation of the hip is a major source of disability for children with cerebral palsy, with the incidence ranging between 3% and 75%.1-4) Hip dislocation and subluxation are caused by multiple factors including contraction of muscles, a deformed proximal femur and acetabular defi ciency. 5,6) Contraction of the adductor and fl exor muscles leads to disturbances of the muscular balance of the hip joint region, to deformation of the acetabulum and proximal femur such as coxa valga, 7) increase of anteversion and to subsequent hip dislocation and subluxation.8) These issues gradually worsen the acetabular deformity and defi ciency, aggravating the hip dislocation Background: We evaluated the clinical and radiological results of one-stage correction for cerebral palsy patients. Methods: We reviewed clinical outcomes and radiologic indices of 32 dysplastic hips in 23 children with cerebral palsy (13

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

“…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]. Sankar et al reported good results after one-stage reconstruction, with hip-joint range of motion and walking ability significantly improved.…”

“…Whereas no misalignment of the hip is observed at birth in these patients, the risk of subluxation increases with the disability and ability to walk, which can be classified by using the GMFCS. For all patients, the risk of hip dislocation is ∼35 % [2,21]. In the period before hip surveillance programmes, as described by Hägglund [10], the reason for hip reconstruction often was pain and loss of function.…”

“…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 technique used currently for bony hip reconstruction in cases of decentration in patients with CP is the modified Dega osteotomy [21], which gives a better coverage of the femoral head in the superior and posterior part of the acetabulum.…”

“…The standard surgical technique in our department is a modified Dega acetabuloplasty, as described by Kim et al [21], in combination with proximal femoral shortening as well as varisation and derotation osteotomy of the proximal femur (VDRSO) (Fig. 1), The bone removed from the femoral osteotomy was then reshaped and placed in the acetabular osteotomy site, as described by Sankar et al and Mallet et al [17,22].…”

Assessment of hip development in the early period in patients who underwent dega osteotomy due to developmental dysplasia of the hip

“…The involvement of lateral growth plate of femoral head, especially in type 2 AVN, emerges at the age of 10 years in average (35). In a study performed by Kim et al, AVN was detected only in 2 hips and it was detected in 6 patients in another study (17,36). In our study, the symptoms of AVN were confirmed totally in 10 hips; however, of those, 6 were type 1.…”