Which procedure gives best results in reconstructing dislocated hip joints in cerebral palsy?
A retrospective study of the surgical repair of dislocated or subluxed hip joints in patients with spastic cerebral palsy was carried out to determine the procedure with the lowest recurrence rate. An open reduction and a corrective femoral osteotomy were combined with different pelvic osteotomies and different interventions on the iliopsoas muscle in most cases. The radiological results in 58 hip joints of 42 patients were assessed with a follow-up time of 5.9 years on average (2.8 to 11.0 years). Although some combined procedures were carried out in only an small number of cases, we can still draw some conclusions. The results were better, if a pelvic osteotomy and an intervention on the iliopsoas muscle were performed. An additional iliopsoas transfer made the hip joints more stable over the long term than lengthening. For severely deformed acetabula the Pemberton osteotomy was superior to the Chiari osteotomy. The Salter osteotomy was a good alternative in cases with mild subluxation. With some combined procedures the redislocation rate was as high as 66%, whereas the combination of an open reduction, a femoral osteotomy, an iliopsoas transfer and a Pemberton or Salter osteotomy gave a redislocation rate of only 11%. A concentric reduction of the hip joints was necessary. Primarily noncentered joints did not improve during the later course.
Brunner
R
R
Division of Pediatric Orthopedics, University of Basel, Switzerland.
D000077:Acetabulum / Q000601:surgery; D000293:Adolescent; D000328:Adult; D002547:Cerebral Palsy / Q000000981:diagnostic imaging / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005269:Femur / Q000601:surgery; D005500:Follow-Up Studies; D006617:Hip Dislocation / Q000000981:diagnostic imaging / Q000601:surgery*; D006621:Hip Joint / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D008297:Male; D010027:Osteotomy / Q000379:methods; D011187:Posture / Q000502:physiology; D016658:Psoas Muscles / Q000601:surgery; D011859:Radiography; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome; D016138:Walking / Q000502:physiology