[Bilateral hip dislocation in cerebral palsy children: conservative therapy of the less affected hip and adductor tenotomy of the opposite hip].
OBJECTIVE
In cerebral palsy children with bilateral hip dislocation, a new therapeutic concept was established that treated the less affected hip conservatively and the more affected hip simultaneously with an adductor tenotomy. The current study assessed whether the clinical and radiological outcome was equal to that of established bilateral surgical treatments. We also examined whether this approach leads to an adequate motor function improvement of the affected children.


METHODS
In 41 children with cerebral palsy and bilateral hip dislocation, a prospective study assessed the hip abduction, migration percentage (MP) and the motor function (Rancho los Amigos scale). Depending on the pretherapeutic status, all patients were grouped into 3 abduction and 3 MP groups. The less affected hip was treated with a hip abduction splint whereas the more affected hip of the same child was simultaneously treated with a subcutaneous adductor tenotomy. All patients were assessed annually for 4 years.


RESULTS
The hip abduction of the conservatively treated hips was pretherapeutically 41.8 +/- 2.6 degrees and improved significantly after 1 year. Patients with a pretherapeutic hip abduction < or = 20 degrees showed the most improvement. After 4 years, a significant deterioration of abduction was avoided in 49%. The pretherapeutic MP of the conservatively treated hips was 31.6 +/- 3.4% and was significantly but only slightly improved. The 4 year MP was significantly improved and the largest improvement was observed when the pretherapeutic MP was larger than 50%. A significant MP improvement after 4 years was achieved in 54%. After 4 years, 34% had undergone a motor function improvement. In 7% a motor function deterioration was observed. Posttherapeutically, the conservatively treated hips showed abduction and MP values that were comparable to those of surgically treated hip joints.


CONCLUSIONS
In cerebral palsy children with bilateral hip dislocation, the conservative treatment of the less affected hip is suitable to achieve clinical and radiological results that are equal to the surgical treatment of the more affected hip. The concept of a combined conservative and surgical treatment of bilateral hip dislocation leads to an adequate motor function improvement that is comparable to established bilateral treatments.
Rolauffs
B
B
Klinik für Unfall- und Wiederherstellungschirurgie an der Eberhard-Karls-Universität Tübingen, BG-Unfallklinik Tübingen. berndrolauffs@googlemail.com
Bahrs
C
C
Ochs
G B
GB
Aurich
M
M
Weise
K
K
Stuby
F
F
D000293:Adolescent; D002370:Casts, Surgical; D002547:Cerebral Palsy / Q000000981:diagnostic imaging / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006617:Hip Dislocation / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D011182:Postoperative Care; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D011859:Radiography; D016059:Range of Motion, Articular / Q000502:physiology; D013165:Splints; D013710:Tendons / Q000601:surgery*