Slotted acetabular augmentation, alone or as part of a combined one-stage approach for treatment of hip dysplasia in adolescents with cerebral palsy: results and complications in 19 hips.
BACKGROUND
Surgical correction for the challenging combined deformities in hip dysplasia associated with cerebral palsy remains controversial. The purpose of this study was to assess the efficacy and determine the role of slotted acetabular augmentation (SAA) for the treatment of neuromuscular hip dysplasia in comparison with other treatment options.


METHODS
We retrospectively analyzed 19 dysplastic hips in 19 patients with cerebral palsy who underwent SAA, alone or as part of a combined 1-stage approach, consisting of soft tissue lengthening and/or a proximal femoral osteotomy, during a 20-year period.


RESULTS
The mean age at the time of operation was 14 years and 7 months (range: 12 to 17 years and 11 months). All had a closed triradiate cartilage. In 13 hips, preoperative radiographs showed major aspheric femoral head deformities. All had subluxation or dislocation of the hip and severe acetabular dysplasia, associated with a painful hip in 15 patients. Before operation, the mean migration index was 64+/-18%, the mean Sharp angle was 51+/-4 degrees, and the mean center-edge angle was -4+/-13 degrees. On immediate postoperative radiographs, they were 3+/-5%, 35+/-5 degrees, and 42+/-11 degrees. At final follow-up, the average migration index was 10+/-8%, the mean Sharp angle was 35+/-6 degrees, and the mean center-edge angle was 39+/-13 degrees. Eleven hips required soft tissue lengthening and 5 hips had a proximal femoral osteotomy at the time of the shelf procedure. At the latest follow-up (mean duration: 5 years and 5 months), 16 of the 19 hips remained anatomically reduced.


CONCLUSIONS
Our results suggest that SAA is a successful procedure to treat advanced neurogenic acetabular dysplasia with or without femoral head deformities in skeletally mature patients.
Luegmair
Matthias
M
Department of Orthopaedic Surgery, University of Innsbruck, Innsbruck, Austria. matthias.luegmair@uki.at
Vuillerot
Carole
C
Cunin
Vincent
V
Sailhan
Frédéric
F
Berard
Jérôme
J
D000077:Acetabulum / Q000002:abnormalities* / Q000601:surgery*; D000293:Adolescent; D002547:Cerebral Palsy / Q000150:complications*; D002648:Child; D005260:Female; D005270:Femur Head / Q000002:abnormalities / Q000601:surgery; D006618:Hip Dislocation, Congenital / Q000601:surgery*; D006801:Humans; D008297:Male; D010027:Osteotomy / Q000379:methods; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome