Proximal Femoral Resection for Older Children With Spastic Hip Disease

Abstract

SUMMARY Thirteen patients (19 hips) who underwent proximal femoral resection arthroplasty for symptomatic subluxation or dislocation of the hip were reviewed retrospectively. All had severe neurological involvement, and when older were non‐ambulatory with spastic quadriplegia or myelodysplasia. Resections were either at the level of the neck (nine hips) or in the subtrochanteric region (10 hips). The latter provided a better operative result than did the former. Poor clinical results noted were continued pre‐operative pelvic obliquity, postoperative adduction contracture, and bony contact between the pelvis and the remaining proximal femur or its heterotopic ossification. RESUME Reseclion fémorale proximale chez les enfanfs plus ǎgés avec affecfion plaslique de la hanche Une revue rétrospective a été effectuée chez 13 enfants (19 hanches) ayant bénéficié d'une arthroplastie avec resection fernorale proximale pour subluxation symptomatique ou luxation de la hanche. Tous presentaient une atteinte neurologique grave á type de quadriplegie spastique ou de spina bifida et avaient perdu la marche avec I'ǎge. Ies résections furent pratiquées au niveau du col (neufs hanches) ou dans la région sous trochantérienne (dix hanches). La seconde technique fournit de meilleure résultats que la première. Les mauvais résultats cliniques observés ètaient liés à une obliquitté pré‐opératoire continue du bassin, des contractures post‐opératoires en adduction, et un contact osseux entre le bassin et l'extremite proximale du fémur restant ou son ossification hétérotopique. ZUSAMMENFASSUNG Proximate Femurresektion bei älteren Kindern mil spasrischer Hüfterkrankung 13 Patienten (19 Hüften) wurden nach proximaler Femurresektionsarthroplastik wegen symptomatischer Subluxation oder Dislokation der Hüfte retrospektiv untersucht. Alle hatten schwere neurologische Befunde und konnten, als sie älter waren, wegen ŝpastischer Tetraplegie oder Myelodysplasie nicht mehr laufen. Die Resektionen wurden entweder in Höhe des Schenkelhalses (neun Hüften) oder in subtrochanterischen Bereich (10 Hüften) durchgeführt. Die letztere Methode hatte bessere Ergebnisse als die erstere. Schlechte klinische Ergebnisse waren fortschreitender präoperativer Beckenschiefstand, postoperative Adduktionskontraktur und Verknöcherung zwischen Becken und dem restlichen proximalen Femur oder seiner heterotopen Ossifikation. RESUMEN Resección femoral proximal en nin̂os mayores con espasticidad de la cadera Se revisaron retrospectivamente trece pacientes (19 caderas) que habian sufrido una artroplastia con reseccibn femoral por padecer una subluxación o dislocación de la cadera. Todos padecian una alteracion neurológica grave y al hacerse mayores no presentaban deambulacion por una cuadriplegia espástica o una mielodisplasia. Las resecciones se hicieron a nivel de cuello (neuve caderas) o a nivel de la region subtrocantérea (10 caderas). Esta ultima opción proporcionó un mejor resultado operativo que la primera. Los resultados clinicos pobres que se re...

Postural care for people with intellectual disabilities and severely impaired motor function: A scoping review

“…Three studies considered the outcomes of surgery. An early retrospective review of older children undergoing proximal femoral resection (where the femoral head and a portion of the femur are removed) for subluxation (partial dislocation) or dislocation of the hip found mixed results, with poor clinical results noted to be continued pre‐operative pelvic obliquity, post‐operative adduction contracture and bony contact between the pelvis and the remaining proximal femur or its heterotopic ossification (bone tissue formation outside of the skeleton) (Perlmutter, Synder, Miller, & Bisbal, ). Of the 13 patients in the study, six had a continued need for pain medication and all of these continued to demonstrate bony contact either by heterotopic ossification or by continued proximal femoral impingement onto the pelvis.…”

Salvage Options in the Cerebral Palsy Hip: A Systematic Review

“…Studies that distinguished pain relief [4][5][6][7][8][9][10][11][12][13][14][15][16][17][20][21][22][24][25][26]28,30 and complication types and rates [4][5][6][7][8][9][10][11][12][13][14][15][16][17][19][20][21][22][24][25][26]28,30 among confirmed nonambulators were included in the analysis. Pain relief rates for femoral head resection (FHR), VO, total hip arthroplasty (THA), shoulder prosthetic interposition (SPI), and arthrodesis were 90.4%, 88.4%, 93.8%, 90.9%, and 56.3%, respectively.…”

Surgical treatment for hip pain in the adult cerebral palsy patient

“…Head and neck resection, or the Girdlestone procedure (Fig. 4), has not been successful in relieving pain as reported by Hoffer 17 and Perlmutter et al 22 . Even with postoperative skeletal traction, these patients continued to have pain.…”

“…Hip pain has been reported to be as high as 50% in those adult patients with hip dysplasia, and generally those patients who are most severely involved have the most significant problems. 5,[15][16][17][18][19][20][21][22] Surgical options for adult CP patients include head and neck resection; interposition arthroplasty (Castle procedure); valgus osteotomy as described by Schantz and Haas,27,28 or the McHale modification 30 ; hip arthrodesis; and total hip replacement.…”