Results of Posterior Iliopsoas Transfer for Hip Instability Caused by Cerebral Palsy

Uematsu, Ariniwa; Bailey, Harry L.; Winter, William G.; Brower, Thomas D.

doi:10.1097/00003086-197707000-00034

Cited by 4 publications

(1 citation statement)

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“…43 However, others report failure rates of 42% 44 and 55%. 45 The pathomechanics of spastic hip disease involve a combination of force vectors in the wrong direction; therefore, when the force vector is too high, this procedure does not make good theoretical sense as a treatment for spastic hip disease. Based on the published reports of extremely high failure rates and the poor theoretical benefit, this procedure should not be used in the treatment of spastic hip subluxation or dislocation.…”

Section: Iliopsoas Transfermentioning

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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Section: Iliopsoas Transfermentioning

confidence: 99%