Management of hip disorders in patients with cerebral palsy.
Hip disorders are common in patients with cerebral palsy and cover a wide clinical spectrum, from the hip at risk to subluxation, dislocation, and dislocation with degeneration and pain. Although the hip is normal at birth, a combination of muscle imbalance and bony deformity leads to progressive dysplasia. The spasticity or contracture usually involves the adductor and iliopsoas muscles; thus, the majority of hips subluxate in a posterosuperior direction. Many patients with untreated dislocations develop pain by early adulthood. Because physical examination alone is unreliable, an anteroposterior radiograph of the pelvis is required for diagnosis. Soft-tissue lengthening is recommended for children as soon as discernable hip subluxation (hip abduction <30 degrees, migration index >25%) is recognized. One-stage comprehensive hip reconstruction is effective treatment for children 4 years of age or older who have a migration index >60% but who have not yet developed advanced degenerative changes of the femoral head. Salvage options for the skeletally mature patient with a neglected hip are limited.
Flynn
John M
JM
Orthopaedics, Division of Orthopaedic Surgery, The Children's Hospital of Philadelphia, PA 19104-4399, USA.
Miller
Freeman
F
D000293:Adolescent; D000328:Adult; D002547:Cerebral Palsy / Q000150:complications*; D002648:Child; D002675:Child, Preschool; D006621:Hip Joint / Q000033:anatomy & histology / Q000601:surgery*; D006801:Humans; D007592:Joint Diseases / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D019637:Orthopedic Procedures / Q000009:adverse effects / Q000379:methods*