title: Extreme femoral shortening: an approach to the chronically dislocated hip in the nonambulatory pediatric population.
abstract: There are many surgical techniques for treating the chronically dislocated, painful hip in patients with neuromuscular spasticity, but each has significant complication rates. We conducted a study to examine the outcomes of a novel technique, an extreme varus femoral shortening osteotomy, used in nonambulatory patients with neuromuscular spasticity. Patients who underwent the procedure were identified retrospectively by surgical codes. Medical records were reviewed for range of motion, pain and functional assessment, surgical indications, complications, and results. In addition, preoperative and postoperative radiographs were assessed, and caretaker questionnaires reviewed. Between 2001 and 2010, 1 surgeon performed 6 femoral shortening osteotomies in 5 nonambulatory patients with neuromuscular spasticity. In all 5 cases, there were improvements in pain, sitting tolerance, ease of hygiene, and ease of transfers at a minimum follow-up of 2 years (mean, 3.4 years). Postoperative complications included asymptomatic heterotopic ossification and recurrent subluxation. Extreme femoral shortening is a reproducible surgical technique that alleviates pain and makes hygiene easier in nonambulatory children with symptomatic hip dislocations caused by neuromuscular spasticity. Our complication rate was comparable to that of other procedures.
authors.affiliation: Department of Orthopaedic Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Orthopaedic Surgery, Northwestern University, Chicago, IL. j-kalwadia@northwestern.edu.
authors.forename: Jay V
authors.initials: JV
authors.lastname: Kalawadia
authors.forename: Ronak M
authors.initials: RM
authors.lastname: Patel
authors.forename: Layne
authors.initials: L
authors.lastname: Jensen
authors.forename: John
authors.initials: J
authors.lastname: Sarwark
mesh_terms: D000293:Adolescent; D002648:Child; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D006617:Hip Dislocation / Q000150:complications / Q000601:surgery*; D006621:Hip Joint / Q000601:surgery*; D006801:Humans; D008297:Male; D009128:Muscle Spasticity / Q000150:complications / Q000601:surgery*; D010027:Osteotomy / Q000379:methods*; D016059:Range of Motion, Articular; D016896:Treatment Outcome