The severely unstable hip in cerebral palsy. Treatment with open reduction, pelvic osteotomy, and femoral osteotomy with shortening.

Root, Leon; Laplaza, F. Javier; Brourman, Steven; Angel, David

doi:10.2106/00004623-199505000-00006

Cited by 105 publications

(60 citation statements)

References 21 publications

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“…Shea et al [12] reported no fractures in 15 patients with CP who underwent a Pemberton pericapsular osteotomy to treat a dysplastic hip. In a study by Mubarak et al [1], 1 of 11 patients sustained a fracture after pericapsular acetabuloplasty and spica stabilization, and Root et al [13] observed femoral fractures in 3 of 31 patients with CP who had an open reduction, pelvic osteotomy, and femoral osteotomy with shortening with stabilization using a spica cast. Of 47 patients with spastic CP, Brunner et al [3] observed 2 to sustain a femoral fracture within 3 months of surgical reconstruction of a dislocated or subluxated hip stabilized using a spica cast.…”

Section: Discussionmentioning

confidence: 99%

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

Albrektson

Kay

Tolo

et al. 2007

Journal of Children's Orthopaedics

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Background Studies have shown that when using a spica cast following hip surgery in children , there are associated complications such as soiling, pressure sores, and osteopenic fractures. Methods Charts were retrospectively reviewed for all patients who had undergone hip surgeries by one surgeon at one institution between 1999 and 2005. The method of post-operative immobilization (spica cast or abduction pillow) and complications were recorded for each patient.

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Section: Discussionmentioning

confidence: 99%

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

Albrektson

Kay

Tolo

et al. 2007

Journal of Children's Orthopaedics

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“…Todos os nossos pacientes operados estavam sem queixas de dor no pós-operatório, tendo tido alto grau de satisfação por parte dos familiares, o que vai de acordo com a literatura (3,6,8,11,12) . Concordamos com Root et al (8) , que referem que todos os pacientes após o procedimento cirúrgico de reconstrução de quadril tiveram um melhor posicionamento para sentar e não referiram mais dor no pós-operatório, e mesmo sendo uma cirurgia que pode apresentar suas complicações, os bons resultados justificam os cuidados, tratamento e atenção a esses pacientes.…”

Section: Discussionunclassified

“…Concordamos com Root et al (8) , que referem que todos os pacientes após o procedimento cirúrgico de reconstrução de quadril tiveram um melhor posicionamento para sentar e não referiram mais dor no pós-operatório, e mesmo sendo uma cirurgia que pode apresentar suas complicações, os bons resultados justificam os cuidados, tratamento e atenção a esses pacientes.…”

Section: Discussionunclassified

“…Estão muito bem documentados na literatura os bons resultados do tratamento cirúrgico nesta patologia, a fim de garantir um quadril anatômico e indolor, através da osteotomia varizante do fêmur proximal e da osteotomia pélvica (5)(6)(7)(8) ; porém pouco se tem escrito sobre a necessidade ou não da abertura da cápsula articular a fim de melhorar a estabilização desse quadril.…”

Section: Introductionunclassified

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Tratamento da luxação paralítica do quadril na paralisia cerebral tetraparética espástica com osteotomia do fêmur e do ilíaco sem abertura da cápsula articular (capsuloplastia)

Farcetta¹,

Abreu²,

Neves³

et al. 2010

Rev. bras. ortop.

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“…[6][7][8][9] Reported complication rates for hip reconstructive surgery in patients with CP have varied dramatically (0% to 81%). 8,[10][11][12][13][14][15][16][17][18] There has been minimal attention paid to the development of avascular necrosis (AVN) as a complication of hip reconstructions. The incidence of AVN reported within the literature is in the range of 0% to 69%.…”

Section: Introductionmentioning

confidence: 99%

Avascular necrosis in children with cerebral palsy after reconstructive hip surgery

2015

Develop Med Child Neuro

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Purpose Progressive hip displacement is one of the most common orthopaedic pathologies in children with cerebral palsy (CP). Reconstructive hip surgery has become the standard treatment of care. Reported avascular necrosis (AVN) rates for hip reconstructive surgery in these patients vary widely in the literature. The purpose of this study is to identify the frequency and associated risk factors of AVN for reconstructive hip procedures.Methods A retrospective analysis was performed of 70 cases of reconstructive hip surgery in 47 children with CP, between 2009 and 2013. All 70 cases involved varus derotation osteotomy (VDRO), with 60% having combined VDRO and pelvic osteotomies (PO), and 21% requiring open reductions. Mean age at time of surgery was 8.82 years and 90% of patients were Gross Motor Function Classification System (GMFCS) 4 and 5. Radiographic dysplasia parameters were analysed at selected intervals, to a minimum of one year post-operatively. Severity of AVN was classified by Kruczynski's method. Bivariate statistical analysis was conducted using Chi-square test and Student's t-test.Results There were 19 (27%) noted cases of AVN, all radiographically identifiable within the first post-operative year. The majority of AVN cases (63%) were mild to moderate in severity. Pre-operative migration percentage (MP) (p = 0.0009) and post-operative change in MP (p = 0.002) were the most significant predictors of AVN. Other risk factors were: GMFCS level (p = 0.031), post-operative change in NSA (p = 0.02) and concomitant adductor tenotomy (0.028). Conclusion AVN was observed in 27% of patients. Severity of displacement correlates directly with AVN risk and we suggest that hip reconstruction, specifically VDRO, be performed early in the 'hip at risk' group to avoid this complication.Cite this article: Phillips L, Hesketh K, Schaeffer EK, Andrade J, Farr J, Mulpuri K. Avascular necrosis in children with cerebral palsy after reconstructive hip surgery. J Child Orthop

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The severely unstable hip in cerebral palsy. Treatment with open reduction, pelvic osteotomy, and femoral osteotomy with shortening.

Cited by 105 publications

References 21 publications

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

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

Tratamento da luxação paralítica do quadril na paralisia cerebral tetraparética espástica com osteotomia do fêmur e do ilíaco sem abertura da cápsula articular (capsuloplastia)

Avascular necrosis in children with cerebral palsy after reconstructive hip surgery

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