title: Resection arthroplasty of the hip for patients with cerebral palsy: an outcome study.
abstract: Thirteen patients (18 hips) with cerebral palsy and painful hip subluxation or dislocation underwent proximal femoral resection-interposition arthroplasty (PFRIA) as a salvage procedure for intractable pain or seating difficulty. Eleven patients (14 hips) had a prior failed soft-tissue or bony reconstruction. The average age at surgery was 26.6 years (range, 10.7-45.5 years), and average follow-up was 7.4 years (range, 2.2-20.8 years). All patients/caregivers noted significant improvement in subjective assessment of pain after the surgery. Upright sitting tolerance improved from an average preoperative value of 3.2-8.9 h postoperatively (p < 0.01). Four patients who were unable even to sit in a customized wheelchair before the operation could be easily seated in a custom chair after surgery. Hip range of motion including flexion, extension, and abduction was significantly improved postoperatively (p < 0.05). Single-dose radiation therapy was used postoperatively for five hips and resulted in a significantly lower grade of heterotopic ossification at final follow-up (p < 0.005). Skeletal traction in the postoperative period did not prevent proximal migration of the femur compared with skin traction. Maximal pain relief was achieved at an average of 5.6 months postoperatively (range, 0.03-14 months). Complications included transient postoperative decubitus ulceration (four patients), pneumonia (two patients), and symptomatic heterotopic bone (two patients). The significant improvements in pain management, sitting tolerance, and range of motion suggest that PFRIA is a reasonable salvage procedure for the painful, dislocated hip in cerebral palsy. Resolution of pain may not be immediate, as was noted in this series.
authors.affiliation: The Hospital for Special Surgery, New York, NY 10021, USA.
authors.forename: R F
authors.initials: RF
authors.lastname: Widmann
authors.forename: T T
authors.initials: TT
authors.lastname: Do
authors.forename: S M
authors.initials: SM
authors.lastname: Doyle
authors.forename: S W
authors.initials: SW
authors.lastname: Burke
authors.forename: L
authors.initials: L
authors.lastname: Root
mesh_terms: D000293:Adolescent; D000328:Adult; D001178:Arthroplasty / Q000379:methods*; D002547:Cerebral Palsy / Q000150:complications*; D002648:Child; D005069:Evaluation Studies as Topic; D005260:Female; D005270:Femur Head / Q000000981:diagnostic imaging / Q000601:surgery*; D005500:Follow-Up Studies; D006617:Hip Dislocation / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011859:Radiography; D016059:Range of Motion, Articular; D016879:Salvage Therapy; D018709:Statistics, Nonparametric; D016896:Treatment Outcome