Long-Term Follow-Up After One-Stage Reconstruction of Dislocated Hips in Patients With Cerebral Palsy

Abstract

Twelve consecutive patients (average age 10.6 years) with 14 dislocated hips underwent one-stage hip reconstruction between 1973 and 1981. The procedure consisted of (1) adductor myotomy and anterior obturator neurectomy, (2) circumferential capsulotomy, iliopsoas and external rotator tenotomies, and ligamentum teres and pulvinar excision, (3) shortening femoral varus derotational osteotomy, (4) acetabuloplasty, and (5) spica immobilization for 4 weeks. All patients were followed clinically and radiographically at an average of 16.7 (range 12.4-19.5) years. No patients were lost to follow-up. Long-term results revealed complete stability in 13 of 14 hips, with no redislocations or subluxations. The one patient with "instability" had undergone bilateral proximal femoral resections for severe arthritis 12 years after left hip reconstruction; at the time of resection, the left hip was stable and reduced. Pain was absent in 13 of 14 hips. There were no problems with perineal care, decubitus formation, or sitting tolerance. Extension and abduction improved an average of 23 degrees and 10 degrees, respectively. Two patients' ambulatory status improved; none deteriorated. The mean center-edge angle was 35 degrees (range 22-50 degrees), and the mean migration percentage was 10.6% (range 0-31%). Complications included one case of degenerative arthritis, one case of painless coxa vara, and three episodes of supracondylar femur fractures. None of these patients developed radiographic evidence of avascular necrosis. In the authors' experience, one-stage hip reconstruction consisting of soft tissue lengthening, open reduction, femoral osteotomy, and pericapsular acetabuloplasty results in a painless, mobile, and stable hip at long-term follow-up that greatly improves the patient's quality of life.

Risk factors and complications in hip reconstruction for nonambulatory patients with cerebral palsy

“…Analyzed (n =61; 93 hips) (Table 4) [4][5][6][7][8][9][10][11][12][13][14][15][16][17]. Our rate may also be elevated by the choice to include the category of ''failure to cure'' as a complication, rather than the more common practice to review the patient's perioperative course for complications related to the procedure.…”

“…While the reported complication rates for hip reconstructive surgery in patients with CP have varied considerably (0-81 %), [4][5][6][7][8][9][10][11][12][13][14][15][16][17] it is difficult if not impossible to compare studies since all but one [18] are based upon mixed populations of ambulators and nonambulators with no uniformity in defining a complication. Severity of disease, as indicated by limited ambulatory ability, the presence of a tracheostomy or gastrostomy, and Gross Motor Function Classification System (GMFCS), has been shown to be an important determinant for both the incidence of hip displacement and the risk of complications [16].…”

Abduction pillow immobilization following hip surgery: A welcome alternative for selected patients

“…Miller et al [8] described there being no fractures in 51 patients with dysplastic spastic hips after surgery, followed 2-3 days later by physical therapy with no form of immobilization. Decubiti ulcers have been reported in 7 of 76 (9%) patients by Stasikelis et al [7] and 0 of 14 (0%) by Sankar et al [9] In order to decrease the risks associated with spica casts, all patients with no diagnosis of developmental dysplasia of the hip (DDH) were placed in an abduction brace postoperatively. We present our experience using abduction pillows post-operatively following hip surgery.…”

Percutaneous pelvic osteotomy in cerebral palsy patients: Surgical technique and indications

“…In 50%-70% of CP patients, hip displacement can make perineal care difficult [2,3,[9][10][11][12][13] , alter sitting balance [13][14][15] , and be a source of pain [2,3,[14][15][16][17][18] . Most clinicians agree that surgical treatment is indicated for progressive hip subluxation in this patient population [3,4,[18][19][20][21] . The goal of any treatment is to create a reduced, stable, mobile hip with reduction of existing pain.…”