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

Canavese, Federico

doi:10.5312/wjo.v4.i4.279

Cited by 6 publications

(1 citation statement)

References 38 publications

(71 reference statements)

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“…Severe acetabular dysplasia (AI of >25°) in CP can be addressed with surgical procedures redirecting (e.g., Salter osteotomy), reshaping (e.g., Albee, Dega, Pemberton, or San Diego osteotomy) and salvaging/augmenting the depth of the acetabulum (e.g., shelf and Chiari osteotomies). 86 The San Diego pericapsular acetabuloplasty hinges symmetrically on or slightly above the triradiate cartilage, with bone grafts providing posterior coverage equal to the anterior coverage. 87 The Albee, Dega, Pemberton, and San Diego osteotomies reduce the volume and shape of the acetabulum by increasing its lateral coverage without a significant reduction in the posterior coverage.…”

Section: Hip S Urgerymentioning

confidence: 99%

Orthopedic surgery in cerebral palsy: Instructional course lecture

Sharan¹

2017

IJOO

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Orthopedic surgery (OS) plays an important role in the management of cerebral palsy (CP). The objectives of OS are to optimize functions and prevent deformity. Newer developments in OS for CP include emphasis on hip surveillance, minimally invasive procedures, use of external fixators instead of plates and screws, better understanding of lever arm dysfunctions (that can only be corrected by bony OS), orthopedic selective spasticity-control surgery, and single-event multilevel lever arm restoration and anti spasticity surgery, which have led to significant improvements in gross motor function and ambulation, especially in spastic quadriplegia, athetosis, and dystonia. The results of OS can be dramatic and life altering for the person with CP and their caregivers if it is performed meticulously by a specialized surgical team, at the appropriate age, for the correct indications, employing sound biomechanical principles and is followed by physician-led, protocol based, intensive, multidisciplinary, institutional rehabilitation, and long term followup. However, OS can be a double-edged sword, and if performed less than optimally, and without the supporting multidisciplinary medical and rehabilitation team, expertise and infrastructure, it often leads to significant functional worsening of the person with CP, including irretrievable loss of previous ambulatory capacity. OS must be integrated into the long term management of the person with CP and should be anticipated and planned at the optimal time and not viewed as a “last resort” intervention or failure of rehabilitation. This instructional course lecture reviews the relevant contemporary principles and techniques of OS in CP.

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Section: Hip S Urgerymentioning

confidence: 99%

Orthopedic surgery in cerebral palsy: Instructional course lecture

Sharan¹

2017

IJOO

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Results and complications of percutaneous pelvic osteotomy and intertrochanteric varus shortening osteotomy in 54 consecutively operated GMFCS level IV and V cerebral palsy patients

Canavese

Marengo

Coulon

2017

Eur J Orthop Surg Traumatol

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Minimally invasive Dega acetabuloplasty for the treatment of neuromuscular hip dysplasia

Kappa

Shore

Allar

et al. 2018

Current Orthopaedic Practice

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Background: Dega acetabuloplasty is used in the management of neuromuscular hip dysplasia. A minimally invasive technique may decrease perioperative morbidity while allowing for adequate reduction and ensuring stability. We sought to determine the impact of a minimally invasive Dega acetabuloplasty (MID) on hip stability after neuromuscular hip reconstructions. Methods: A retrospective review was performed of consecutive patients with cerebral palsy (GMFCS IV/V) and neuromuscular hip dysplasia undergoing bony reconstruction including a varus derotational osteotomy (VDRO) of the femur and a Dega acetabuloplasty. Clinical records were reviewed to evaluate preoperative comordibities and clinical complications. Review of pelvic radiographs preoperatively and at follow-up evaluated correction of acetabular index, migration percentage, and the presence of an intact Shenton’s arc. Results: Forty-two patients (45 hips) underwent MID surgery as part of a reconstructive approach for neuromuscular hip subluxation or dislocation. Preoperative migration percentage averaged 61.1±4.0% (range, 39-100%). In addition to bony reconstructions, 91.4% of hips had soft-tissue balancing. Patients had an average estimated blood loss of 102±69.9 cc, mean operative time of 165±44 min, and an average length of stay of 3.2±1.3 days. No patient required reoperation. Operative intervention resulted in a mean migration percentage of 12.1%±2.5 and residual acetabular index of 16.0±8.7 degrees with 84.4% (38 of 45) of hips having an intact Shenton’s arc at 1-year of follow-up. Conclusions: The MID provides acceptable rates of postoperative hip stability at 1 yr with low blood loss, surgical time, length of stay, and postoperative medical complications. Level of Evidence: Level IV.

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

Cited by 6 publications

References 38 publications

Orthopedic surgery in cerebral palsy: Instructional course lecture

Orthopedic surgery in cerebral palsy: Instructional course lecture

Results and complications of percutaneous pelvic osteotomy and intertrochanteric varus shortening osteotomy in 54 consecutively operated GMFCS level IV and V cerebral palsy patients

Minimally invasive Dega acetabuloplasty for the treatment of neuromuscular hip dysplasia

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