title: Percutaneous pelvic osteotomy in cerebral palsy patients: Surgical technique and indications.
abstract: OBJECTIVE
  To describe the surgical technique of and indications for percutaneous pelvic osteotomy in patients with severe cerebral palsy.
  
  
  METHODS
  Twenty-one non-ambulatory children and adolescents (22 hips) were consecutively treated with percutaneous pelvic osteotomy, which was used in conjunction with varus, derotational, shortening femoral osteotomy and soft tissue release, to correct progressive hip subluxation and acetabular dysplasia. The age, gender, Gross Motor Function Classification System level, side(s) of operated hip, total time of follow-up, immediate post-operative immobilization, complications, and the need for revision surgery were recorded for all patients.
  
  
  RESULTS
  Seventeen patients (81%) were classified as GMFCS level IV, and 4 (19%) patients were classified as GMFCS level V. At the time of surgery, the mean age was 10.3 years (range: 4-15 years). The mean Reimers' migration percentage improved from 63% (range: 3%-100%) pre-operatively to 6.5% (range: 0%-70%) at the final follow-up (P < 0.05). The mean acetabular angle (AA) improved from 34.1° (range: 19°-50°) pre-operatively to 14.1° (range: 5°-27°) (P < 0.05). Surgical correction of MP and AA was comparable in hips with open (n = 14) or closed (n = 8) triradiate cartilage (P < 0.05). All operated hips were pain-free at the time of the final follow-up visit, although one patient had pain for 6 mo after surgery. We did not observe any cases of bone graft dislodgement or avascular necrosis of the femoral head.
  
  
  CONCLUSIONS
  Pelvic osteotomy through a less invasive surgical approach appears to be a valid alternative with similar outcomes to those of standard techniques. This method allows for less muscle stripping and blood loss and a shorter operating time.
authors.affiliation: Federico Canavese, Marie Rousset, Antoine Samba, Pediatric Surgery Department, University Hospital Estaing, 63003 Clermont-Ferrand, France.
authors.forename: Federico
authors.initials: F
authors.lastname: Canavese
authors.forename: Marie
authors.initials: M
authors.lastname: Rousset
authors.forename: Antoine
authors.initials: A
authors.lastname: Samba
authors.forename: Geraldo
authors.initials: G
authors.lastname: de Coulon
keywords: Acetabular dysplasia; Cerebral palsy; Children; Hip; Non-ambulatory; Percutaneous pelvic osteotomy