A Dega-type osteotomy after closure of the triradiate cartilage in non-walking patients with severe cerebral palsy.
A total of 47 non-walking patients (52 hips) with severe cerebral palsy and with a mean age of 14 years, (9 to 27) underwent a Dega-type pelvic osteotomy after closure of the triradiate cartilage, together with a derotation varus-shortening femoral osteotomy and soft-tissue correction for hip displacement which caused pain and/or difficulties in sitting. The mean follow-up was 48 months (12 to 153). The migration percentage improved from a pre-operative mean of 70% (26% to 100%) to 10% (0% to 100%) post-operatively. In five hips the post-operative migration percentage was greater than 25%, which was associated with continuing pain in two patients. Three patients had persistent hip pain and a migration percentage less than 25%. In five hips a fracture through the acetabulum occurred, and in another there was avascular necrosis of the superior acetabular segment, but these had no adverse effect on functional outcome. We conclude that it is possible to perform a satisfactory pelvic osteotomy of this type in these patients after the triradiate cartilage has been closed.
Robb
J E
JE
Royal Hospital for Sick Children, Edinburgh EH9 1LF, UK. james.robb@luht.scot.nhs.uk
Brunner
R
R
D000077:Acetabulum; D000293:Adolescent; D000328:Adult; D019644:Arthroplasty, Replacement, Hip / Q000379:methods; D002358:Cartilage, Articular / Q000601:surgery*; D002547:Cerebral Palsy / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D002648:Child; D005269:Femur / Q000601:surgery; D006617:Hip Dislocation / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D006621:Hip Joint / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D010027:Osteotomy / Q000379:methods*; D010146:Pain / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D010388:Pelvis / Q000601:surgery*; D011183:Postoperative Complications; D016896:Treatment Outcome