Clin Orthop Surg.  2012 Jun;4(2):139-148. 10.4055/cios.2012.4.2.139.

Early Results of One-Stage Correction for Hip Instability in Cerebral Palsy

Affiliations
  • 1Department of Orthopaedic Surgery, Pusan National University Hospital, Busan, Korea. kimht@pusan.ac.kr

Abstract

BACKGROUND
We evaluated the clinical and radiological results of one-stage correction for cerebral palsy patients.
METHODS
We reviewed clinical outcomes and radiologic indices of 32 dysplastic hips in 23 children with cerebral palsy (13 males, 10 females; mean age, 8.6 years). Ten hips had dislocation, while 22 had subluxation. Preoperative Gross Motor Function Classification System (GMFCS) scores of the patients were as follows; level V (13 patients), level IV (9), and level III (1). Acetabular deficiency was anterior in 5 hips, superolateral in 7, posterior in 11 and mixed in 9, according to 3 dimensional computed tomography. The combined surgery included open reduction of the femoral head, release of contracted muscles, femoral shortening varus derotation osteotomy and the modified Dega osteotomy. Hip range of motion, GMFCS level, acetabular index, center-edge angle and migration percentage were measured before and after surgery. The mean follow-up period was 28.1 months.
RESULTS
Hip abduction (median, 40degrees), sitting comfort and GMFCS level were improved after surgery, and pain was decreased. There were two cases of femoral head avascular necrosis, but no infection, nonunion, resubluxation or redislocation. All radiologic indices showed improvement after surgery.
CONCLUSIONS
A single event multilevel surgery including soft tissue, pelvic and femoral side correction is effective in treating spastic dislocation of the hip in cerebral palsy.

Keyword

Cerebral palsy; Hip dislocation; Single event multilevel surgery; Dega osteotomy

MeSH Terms

Adolescent
Arthroplasty/*methods
Cerebral Palsy/*complications
Child
Child, Preschool
Female
Hip Dislocation/*etiology/*surgery
Hip Joint/pathology/radiography/*surgery
Humans
Male
Osteotomy
Pain/etiology
Range of Motion, Articular
Tomography, X-Ray Computed
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