Treatment of the Painful Chronically Dislocated and Subluxated Hip in Cerebral Palsy With Hip Arthrodesis

Fucs, Patrícia Maria de Moraes Barros; Svartman, Celso; Assumpção, Rodrigo Montezuma César de; Kertzman, Paulo F

doi:10.1097/01241398-200307000-00021

Cited by 30 publications

(27 citation statements)

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“…However, there are papers finding total hip arthroplasty a reasonable alternative for treatment of paralytic hip in older aged group of patients highlighting strict selection in indications for surgery [25]. De Moraes [7] reports good experience with arthrodesis as a solution for treatment of 124 children with average age 15,4 years. Most authors recommend either subcapital or subtrochanteric proximal femoral resection [4-6, 14, 24].…”

Section: Discussionmentioning

confidence: 99%

Irreducible dislocation of the hip in cerebral palsy patients treated by Schanz proximal femoral valgus osteotomy

Schejbalová

Havlas

Trč

2008

International Orthopaedics (SICOT)

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Palliative Schanz proximal femoral valgus osteotomy is considered a common option for treatment of irreducible hip dislocation in cerebral palsy. From 1992 to 2005, Schanz osteotomy was indicated on 55 occasions in 35 nonambulatory patients with the quadriplegic form of cerebral palsy aged 9-18. Postoperatively, the main emphasis focussed on clinical presentation, improvement of hip range of motion, and pain relief. X-rays were carried out at three, six, and 12 months postoperatively with subsequent average follow up 98±4.5 months. In all patients, the range of hip abduction and flexion increased. In 54 (98.2%) cases painful symptoms significantly improved. One patient (1.8%) had a subsequent femoral head excision because of persistent hip pain. Transient hip pain persisted in four patients (7.3%). Schanz valgus osteotomy improves the hip range of motion, relieves pain, and facilitates care of the patient. Schanz femoral osteotomy is a less invasive method compared to proximal femoral excision and should preferably be used in older children with neurogenic hip dislocation in whom reconstructive surgery is not indicated.Résumé L'ostéotomie de Schanz est considérée comme un traitement possible des luxations irréductible chez l'infirme moteur cérébral. De 1992 à 2005, une ostéotomie de Schanz a été réalisée 55 fois chez 35 patients non marchant et présentant une quadriplégie spastique, ces patients étaient âgés de 9 à 18 ans. La surveillance postopératoire a été centrée sur l'examen clinique, l'amélioration de la mobilité et l'amélioration des phénomènes douloureux. Les radios ont été réalisées à 3, 6 et 12 mois postopératoires avec un suivi moyen de 98 mois ± 4,5 mois. Chez tous les patients la mobilité de la hanche en abduction et en flexion s'est améliorée. Dans 54 cas (98,2%) la diminution de la douleur est significative. Un patient (1,8%) a nécessité d'une résection de la tête fémorale du fait de douleurs persistantes. Une douleur transitoire a persisté chez 4 patients (7,3%). L'ostéotomie de Schanz améliore la mobilité et la douleur de ces patients. Cette intervention est peu invasive comparée à la résection de l'extrémité supérieure du fémur et peut être préférée chez les enfants âgés présentant une luxation neurologique pour lesquels il n'est pas possible de réaliser une reconstruction de la hanche.

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Section: Discussionmentioning

confidence: 99%

Irreducible dislocation of the hip in cerebral palsy patients treated by Schanz proximal femoral valgus osteotomy

Schejbalová

Havlas

Trč

2008

International Orthopaedics (SICOT)

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“…-устранение или снижение болевого синдрома [27,34,35,36,37,38,39]; -устранение порочного положения бедра, возмож-ность его беспрепятственной мобилизации [27,28,34,40,41,42,43]; -улучшение условий ухода за пациентом, в том числе гигиены промежности [27,28,34,40].…”

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“…-артродез тазобедренного сустава [14,35]; -протезирование тазобедренного сустава [14,27,40,44,45]; -проксимальная артропластическая резекция бе-дра [41,42]; -вальгизирующая остеотомия проксимального от-дела бедра в сочетании с резекцией головки или без таковой [26,37,39,46].…”

unclassified

“…Артродез тазобедренного сустава весьма эффек-тивен с точки зрения купирования болевого синдро-ма и улучшения ухода за пациентом, но совершенно исключает мобилизацию бедра [14,35]. De Morraes Barros Fucs [35] сообщает об успешном применении артродеза при лечении 14 пациентов (средний возраст 15,5 лет) с вывихом бедра.…”

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“…De Morraes Barros Fucs [35] сообщает об успешном применении артродеза при лечении 14 пациентов (средний возраст 15,5 лет) с вывихом бедра. Root в двух случаях из вось-ми (возраст вмешательства от 8 до 33 лет) отметил не-сращение в зоне артродеза.…”

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Hip dislocation in adolescents and adults with cerebral palsy: palliative methods of surgical treatment (literature review)

Bidjamshin¹,

Попков²

2017

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Proximal femoral excision with interposition myoplasty for cerebral palsy patients with painful chronic hip dislocation

Patel

Sabharwal

Gooding

et al. 2015

Journal of Children's Orthopaedics

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PurposeProximal femoral excision is a salvage procedure for painful chronic hip dislocation in cerebral palsy (CP) patients. The primary objective of this article is to describe our experience of an amplified interposition myoplasty, with appropriate peri-operative pain and tone management strategies, in a cohort of non-ambulatory CP patients with painful chronic hip dislocation. Our secondary objective is to present the clinical outcomes of these patients.MethodsWe describe our experience in 20 CP patients (25 procedures) at mean 54-month (range 27–169) follow-up with a surgical technique that includes an augmented interposition myoplasty and tone management. The indications for surgery were pain (21 hips), poor sitting tolerance (11) and difficulty with perineal care (8).ResultsThe mean age was 22 years (range 10–40) with 11 patients Gross Motor Function Classification Scale (GMFCS) IV and 9 patients GMFCS V. Mean length of stay was 13 days (3–35). One procedure required revision at 12 months. Mean pain score improved from 7.8 (5–10) pre-operatively to 2.8 (1–5) post-operatively (p < 0.001). Sitting tolerance improved in all patients and in 75 % (15) perineal care was easier.ConclusionsOur interposition myoplasty technique with individualised pain/tone management has good outcomes in this cohort of patients with multiple co-morbidities.Electronic supplementary materialThe online version of this article (doi:10.1007/s11832-015-0662-z) contains supplementary material, which is available to authorized users.

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Treatment of the Painful Chronically Dislocated and Subluxated Hip in Cerebral Palsy With Hip Arthrodesis

Cited by 30 publications

References 7 publications

Irreducible dislocation of the hip in cerebral palsy patients treated by Schanz proximal femoral valgus osteotomy

Irreducible dislocation of the hip in cerebral palsy patients treated by Schanz proximal femoral valgus osteotomy

Hip dislocation in adolescents and adults with cerebral palsy: palliative methods of surgical treatment (literature review)

Proximal femoral excision with interposition myoplasty for cerebral palsy patients with painful chronic hip dislocation

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