Soft-tissue release for spastic hip subluxation in cerebral palsy.
Children with spastic hip subluxation secondary to cerebral palsy were treated with a standard protocol that focused on early detection of the subluxation using physical examination and anteroposterior pelvis radiographs. Using limited hip abduction of < or =30 degrees and subluxation of > or =25% migration percentage as indications, patients had open adductor and iliopsoas lengthenings with immediate postoperative mobilization and no abduction bracing. The protocol was applied to 74 children with a mean age of 4.5 years and had 147 hips surgically addressed. Of these hips initially, 20% were normal (migration percentage <25%), 52% were mildly subluxated (migration percentage 25-39%), 22% were moderately subluxated (migration percentage 40-59%), and 6% were severely subluxated (migration percentage > or =60%). At a final postoperative follow-up of 39 months, 54% of these hips were classified as good (migration percentage <25%), 34% were fair (migration percentage 25-39%), and 12% were poor (migration percentage > or =40%). Of this patient population, 69% were nonambulators and their outcomes were not statistically different from children who could walk. No child developed an abduction contracture or wide-based gait that required treatment. With early detection and applying this treatment algorithm, 80% of children with spastic hip disease should have good or fair outcomes. Longer follow-up will be required to determine how many children will need bony reconstruction to maintain stable and located hips at the conclusion of growth.
Miller
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F
Alfred I. duPont Institute, Wilmington, Delaware 19899, USA.
Cardoso Dias
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Dabney
K W
KW
Lipton
G E
GE
Triana
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M
D002547:Cerebral Palsy / Q000150:complications* / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D005260:Female; D006618:Hip Dislocation, Congenital / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D009128:Muscle Spasticity / Q000150:complications / Q000601:surgery; D018482:Muscle, Skeletal / Q000601:surgery*; D016059:Range of Motion, Articular; D016896:Treatment Outcome