title: Varus derotational osteotomy for spastic hip instability: the roles of femoral shortening and obturator neurectomy.
abstract: Varus derotational osteotomy (VDRO) was used to treat 69 unstable hips in 38 patients with spastic quadriplegia. After a mean follow-up of 5.3 years, the total rate of failure as judged by either need for revision or persistent radiographic instability or dislocation was 26%. Overall outcomes were better for hips that had been more congruent (preoperative migration index < 60%) than for hips that had experienced more migration (P = .027), and more-congruent hips were 9 times more likely to be stable radiographically at follow-up (P < .001). The failure rate for VDRO combined with femoral shortening or obturator neurectomy was lower than that for VDRO alone (P = .035). VDRO is an appropriate option for treating less advanced hip subluxation and may be more reliable when combined with femoral shortening and/or obturator neurectomy. VDRO alone, however, may be insufficient for treating more advanced instability.
authors.affiliation: Arthritis Institute, Inglewood, California, USA.
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Yun
authors.forename: Richard
authors.initials: R
authors.lastname: Severino
authors.forename: Kent
authors.initials: K
authors.lastname: Reinker
mesh_terms: D000293:Adolescent; D000704:Analysis of Variance; D002547:Cerebral Palsy / Q000150:complications* / Q000175:diagnosis; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003131:Combined Modality Therapy; D005260:Female; D005269:Femur / Q000601:surgery*; D005500:Follow-Up Studies; D006617:Hip Dislocation / Q000209:etiology / Q000601:surgery*; D006801:Humans; D007593:Joint Instability / Q000209:etiology / Q000601:surgery; D008297:Male; D009128:Muscle Spasticity / Q000209:etiology / Q000601:surgery; D018482:Muscle, Skeletal / Q000294:innervation / Q000601:surgery*; D010027:Osteotomy / Q000379:methods*; D011336:Probability; D016059:Range of Motion, Articular / Q000502:physiology; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome