title: Avascular necrosis as a complication of the treatment of dislocation of the hip in children with cerebral palsy.
abstract: We investigated the incidence and risk factors for the development of avascular necrosis (AVN) of the femoral head in the course of treatment of children with cerebral palsy (CP) and dislocation of the hip. All underwent open reduction, proximal femoral and Dega pelvic osteotomy. The inclusion criteria were: a predominantly spastic form of CP, dislocation of the hip (migration percentage, MP > 80%), Gross Motor Function Classification System, (GMFCS) grade IV to V, a primary surgical procedure and follow-up of > one year. There were 81 consecutive children (40 girls and 41 boys) in the study. Their mean age was nine years (3.5 to 13.8) and mean follow-up was 5.5 years (1.6 to 15.1). Radiological evaluation included measurement of the MP, the acetabular index (AI), the epiphyseal shaft angle (ESA) and the pelvic femoral angle (PFA). The presence and grade of AVN were assessed radiologically according to the Kruczynski classification. Signs of AVN (grades I to V) were seen in 79 hips (68.7%). A total of 23 hips (18%) were classified between grades III and V. Although open reduction of the hip combined with femoral and Dega osteotomy is an effective form of treatment for children with CP and dislocation of the hip, there were signs of avascular necrosis in about two-thirds of the children. There was a strong correlation between post-operative pain and the severity of the grade of AVN.
authors: University of Medical Sciences, ul. 28 czerwca 1956r 135/147 61-545 Poznan, Poland.
authors: A
authors: A
authors: Koch
authors: University of Medical Sciences, ul. 28 czerwca 1956r 135/147 61-545 Poznan, Poland.
authors: M
authors: M
authors: Jozwiak
authors: University of Medical Sciences, ul. 28 czerwca 1956r 135/147 61-545 Poznan, Poland.
authors: M
authors: M
authors: Idzior
authors: Poznan University of Medical Sciences, ul. Dąbrowskiego 79 (second floor), 60-529 Poznan, Poland.
authors: M
authors: M
authors: Molinska-Glura
authors: University of Medical Sciences, ul. 28 czerwca 1956r 135/147 61-545 Poznan, Poland.
authors: A
authors: A
authors: Szulc
mesh_terms: D000293:Adolescent; D002547:Cerebral Palsy / Q000150:complications*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005271:Femur Head Necrosis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology*; D006617:Hip Dislocation / Q000150:complications* / Q000601:surgery*; D006801:Humans; D015994:Incidence; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology*; D011859:Radiography; D012307:Risk Factors
keywords: AVN; Cerebral palsy; Dega osteotomy; Hip