Femoral Head Resection for Painful Hip Subluxation in Cerebral Palsy

Leet, Arabella I.; Chhor, Kimberlly S.; Launay, Franck; Kier-York, J.; Sponseller, Paul D.

doi:10.1097/00004694-200501000-00016

Cited by 12 publications

(12 citation statements)

References 7 publications

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“…This result is in accordance with the work of Leet et al (2005), who reported that 11 of 15 patients or caregivers would recommend the operation to others in a similar situation. Other authors have also reported good results in most patients (McCarthy et al 1988, Widmann et al 1999, Abu-Rajab and Bennet 2007).…”

Section: Discussionsupporting

confidence: 92%

“…Pain was considerably reduced at the time of follow-up, which is in accordance with the results of Leet et al (2005) who reported a reduction in pain from 8.2 to 2.9 using a visual analog scale. Widmann et al (1999) found that maximal pain relief was achieved at an average of 6 months postoperatively, which is consistent with our experience.…”

Section: Discussionsupporting

confidence: 89%

“…From the first postoperative radiograph to the last follow-up, Leet et al (2005) found a mean proximal femoral migration of 2.5 cm after postoperative skeletal traction or external fixation, which is similar to what we found. Widmann et al (1999) found no significant difference in proximal migration between skeletal and skin traction.…”

Section: Discussionsupporting

confidence: 88%

“…Postoperative skeletal traction was used by McCarthy et al (1988), Widmann et al (1999), and Abu-Rajab and Bennet (2007), while Leet et al (2005) used skin traction in some patients, skeletal traction in others, and external fixation in yet other patients. The duration of traction varied from 3 and 6 weeks.…”

Section: Discussionmentioning

confidence: 99%

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Proximal femoral resection arthroplasty for patients with cerebral palsy and dislocated hips

Knaus

Terjesen

2009

Acta Orthopaedica

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Background and purpose Chronic hip dislocation in non-ambulatory individuals with cerebral palsy (CP) can lead to severe problems, of which pain is often the most severe. We studied the outcome of proximal femoral resection, especially regarding pain, sitting balance, perineal care, and patient satisfaction.Patients and methods During the period 1998–2005, we operated 20 non-ambulatory patients with spastic quadriplegic CP (8 females and 12 males). 13 patients had unilateral dislocation and 7 had bilateral. The mean age at operation was 15 (3–27) years. The indications for operation were chronic hip dislocation plus severe problems with pain (17 patients), perineal care (16), and sitting (10). Patients were followed from 1 to 6 years.Results 14 patients were satisfied with the surgery, 3 were dissatisfied, 2 were uncertain, and 1 patient had died 5 days postoperatively. Of the 15 patients who had suffered from considerable pain before surgery, 8 had complete relief from pain and 7 patients experienced improvement. Of the 2 patients who had had mild pain, 1 was unchanged and 1 patient deteriorated. All patients who had not been able to sit were able to sit after the surgery. Only 1 patient had difficulties with perineal hygiene at follow-up. Postoperative complications included deep vein thrombosis (1 patient) and edema, loss of appetite, and the need for gastrostomy (1 patient). 7 patients had prolonged pain for up to 6 months after surgery. 1 of these was reoperated because of persistent pain due to a bony-spike heterotopic ossification.Interpretation Most patients with chronic hip dislocation and severe pain or other major problems appear to benefit from proximal femoral resection. Pain, sitting ability, and perineal care improved and most patients and caregivers were satisfied.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 89%

Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Proximal femoral resection arthroplasty for patients with cerebral palsy and dislocated hips

Knaus

Terjesen

2009

Acta Orthopaedica

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“…Only one article presented a control group, and this study compared the techniques proposed by Castle and by McHale. 11 …”

Section: Resultsmentioning

confidence: 99%

Hip salvage surgery in cerebral palsy cases: a systematic review

Souza

Mansano

Bovo

et al. 2015

Revista Brasileira de Ortopedia (English Edition)

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Imbalance and muscle spasticity, in association with coxa valga and persistent femoral anteversion, compromises hip development in cases of cerebral palsy and may result in chronic pain and even dislocation. Some of these hips undergo salvage surgery because of the severe impact of their abnormalities in these patients’ quality of life. We conducted a systematic review of the literature to compare the results from the main hip salvage techniques applied to these individuals. The literature search focused on studies that evaluated results from hip salvage surgery in cases of cerebral palsy, published from 1970 to 2011, which are present in the Embase, Medline, PubMed, Cochrane Library and SciELO databases. Although the results were not statistically comparable, this systematic review demonstrates that hip salvage surgery should be indicated after individual evaluation on each patient, due to the wide spectrum of presentations of cerebral palsy. Therefore, it seems that no surgical technique is superior to any other. Rather, there are different indications.

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Irreducible dislocation of the hip in cerebral palsy patients treated by Schanz proximal femoral valgus osteotomy

Schejbalová

Havlas

Trč

2008

International Orthopaedics (SICOT)

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Palliative Schanz proximal femoral valgus osteotomy is considered a common option for treatment of irreducible hip dislocation in cerebral palsy. From 1992 to 2005, Schanz osteotomy was indicated on 55 occasions in 35 nonambulatory patients with the quadriplegic form of cerebral palsy aged 9-18. Postoperatively, the main emphasis focussed on clinical presentation, improvement of hip range of motion, and pain relief. X-rays were carried out at three, six, and 12 months postoperatively with subsequent average follow up 98±4.5 months. In all patients, the range of hip abduction and flexion increased. In 54 (98.2%) cases painful symptoms significantly improved. One patient (1.8%) had a subsequent femoral head excision because of persistent hip pain. Transient hip pain persisted in four patients (7.3%). Schanz valgus osteotomy improves the hip range of motion, relieves pain, and facilitates care of the patient. Schanz femoral osteotomy is a less invasive method compared to proximal femoral excision and should preferably be used in older children with neurogenic hip dislocation in whom reconstructive surgery is not indicated.Résumé L'ostéotomie de Schanz est considérée comme un traitement possible des luxations irréductible chez l'infirme moteur cérébral. De 1992 à 2005, une ostéotomie de Schanz a été réalisée 55 fois chez 35 patients non marchant et présentant une quadriplégie spastique, ces patients étaient âgés de 9 à 18 ans. La surveillance postopératoire a été centrée sur l'examen clinique, l'amélioration de la mobilité et l'amélioration des phénomènes douloureux. Les radios ont été réalisées à 3, 6 et 12 mois postopératoires avec un suivi moyen de 98 mois ± 4,5 mois. Chez tous les patients la mobilité de la hanche en abduction et en flexion s'est améliorée. Dans 54 cas (98,2%) la diminution de la douleur est significative. Un patient (1,8%) a nécessité d'une résection de la tête fémorale du fait de douleurs persistantes. Une douleur transitoire a persisté chez 4 patients (7,3%). L'ostéotomie de Schanz améliore la mobilité et la douleur de ces patients. Cette intervention est peu invasive comparée à la résection de l'extrémité supérieure du fémur et peut être préférée chez les enfants âgés présentant une luxation neurologique pour lesquels il n'est pas possible de réaliser une reconstruction de la hanche.

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Femoral Head Resection for Painful Hip Subluxation in Cerebral Palsy

Cited by 12 publications

References 7 publications

Proximal femoral resection arthroplasty for patients with cerebral palsy and dislocated hips

Proximal femoral resection arthroplasty for patients with cerebral palsy and dislocated hips

Hip salvage surgery in cerebral palsy cases: a systematic review

Irreducible dislocation of the hip in cerebral palsy patients treated by Schanz proximal femoral valgus osteotomy

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