Joint‐preserving Operation for Osteoarthrosis of the Hip in Adult Cerebral Palsy

Nishioka, Eiji; Momota, Kou; Shiba, Naoto; Higuchi, Fujio; Inoue, Akio

doi:10.1046/j.1440-1622.2000.01852.x

Cited by 4 publications

(3 citation statements)

References 7 publications

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“…If patients with hip dysfunction grow up without treatment, the disease will continue to advanced osteoarthritis. After a follow-up period of six-years on eleven hips of adult CP patients who underwent Chiari pelvic osteotomy, Nishioka et al [36] reported that good results could be achieved in 86.6% of cases.…”

Section: Cerebral Palsy (Cp)mentioning

confidence: 99%

The results of Chiari pelvic osteotomy in adolescents with a brief literature review

Karami

Fitoussi

Ilharreborde

et al. 2008

Journal of Children's Orthopaedics

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Purpose Chiari medial displacement osteotomy is a procedure that uses the cancellous bone of the ilium to contain the femoral head and bear weight. It is the most contraversial osteotomy of the hip joint. This study was therefore conducted to determine the results of this osteotomy with mid-term follow-up in children. From 1995From to 2004 Chiari pelvic osteotomies (in 18 patients) were performed. There were 15 male and 3 female patients. The average age at operation was 12.6 years and the mean follow-up was 54 months. The operative technique was as described by Chiari. An iliofemoral approach was used without utilizing a traction table. If there was anterior or anterolateral uncoverage of the femoral head, bone graft augmentation was performed. Results The angle of the osteotomy averaged 12°, with the distance from the acetabulum averaging 3.2 mm. The average displacement was 42%. Of the 20 Chiari osteotomies, 11 were categorized as excellent, 8 as good and one as fair in terms of clinical and radiological results. Student's t test statistics showed improvements in all radiologic parameters of the hip joint (Sharp angle, centeredge angle and coverage of the femoral head). Graft resorption was observed in 25% of the patients. MethodsConclusion There are very rare indications of Chiari osteotomy in patients younger than 10 years. Because of the high rate of graft resorption, Chiari osteotomy should be the last treatment option when there is anterior or anterolateral uncoverage of the hip joint.

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Section: Cerebral Palsy (Cp)mentioning

confidence: 99%

The results of Chiari pelvic osteotomy in adolescents with a brief literature review

Karami

Fitoussi

Ilharreborde

et al. 2008

Journal of Children's Orthopaedics

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“…Several reports promote Chiari pelvic osteotomy [65][66][67] ; however, these same authors report failures from either pain or redislocation in approximately 20% of patients. This failure rate is clearly much higher than the peri-ilial osteotomy reports (Case 10.11).…”

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confidence: 99%

“…The Chiari pelvic osteotomy may have a limited role in adults with painful hip subluxation and severe degenerative arthritis in whom the goal is to avoid total hip replacement, at least temporarily. 66 The Salter redirectional osteotomy is specifically not recommended by Salter himself for children with CP. Other authors have reported using the Salter osteotomy for children with CP [68][69][70] ; however, none of these reports allows any actual assessment of the role of this procedure and the outcomes.…”

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confidence: 99%

Hip

Cerebral Palsy

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The hip joint is the largest joint in the body and is the joint that causes the most problems both from a functional perspective and at the level of walking, sitting, and lying in children with cerebral palsy (CP). Hips in children with CP are normal at birth, and the problems develop slowly as the children grow and deform under the influence of abnormal forces caused by the CP. A second group of children with CP do not actually develop deformity; however, the infantile shape of their proximal femur does not resolve because there is not enough normal force present. In summary, these children develop contractures and increased abnormal forces that lead to dislocation and dysplasia, or alternatively, they fail to resolve the infantile torsional malalignment. After addressing the concerns of equinus contractures in children with CP, hip problems are the next main area of interest to orthopaedists treating these children. The treatment of hip problems has the largest literature base in the area of orthopaedic management of CP. A review of the abstract listings in the National Library of Medicine revealed 496 references published from 1963 to 2000 that address hip problems in children with CP. Although the literature is extensive, much of it does not include any standardized control or standardized radiographic measurements and has a poor description of specific patterns. A substantial body of this literature addresses the natural history of the problem of hip dysplasia, and its etiology has been fairly well understood. The evaluation of treatment outcomes suffers especially from poor categorization, poor standard evaluation procedures, and, most of all, very poor long-term follow-ups. Spastic HipsHip problems in children with CP first need to be divided by children's level of tone into either spastic children or those children who are hypotonic. The spastic (hypertonic) group should also include children with movement disorders such as athetosis and dystonia. The hypertonic hips can be subdivided further by the direction of the dysplasia or the abnormal force into posterosuperior, anterior, inferior and, additionally, by several contracture patterns that may be independent of or concurrent with dysplastic hips. These contracture patterns include windblown hips and hyperabducted hips. The hypotonic hips in children with CP are a little more diffuse and are harder to further categorize.

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Hip Reconstruction in Children with Cerebral Palsy

Miller¹

2017

Cerebral Palsy

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Joint‐preserving Operation for Osteoarthrosis of the Hip in Adult Cerebral Palsy

Abstract: We confirm that usual treatment for osteoarthrosis of the hip was also applicable for osteoarthrosis of the hip in cases of adult cerebral palsy, provided sufficient attention is given to the complications accompanying spastic paralysis.

Cited by 4 publications

References 7 publications

The results of Chiari pelvic osteotomy in adolescents with a brief literature review

The results of Chiari pelvic osteotomy in adolescents with a brief literature review

Hip

Hip Reconstruction in Children with Cerebral Palsy

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