title: Hip Reconstruction in Children With Unilateral Cerebral Palsy and Hip Dysplasia.
abstract: BACKGROUND
  Highly functioning children with unilateral cerebral palsy (CP) who have hip involvement (type IV hemiplegia) may present with hip dysplasia during their adolescence. The aim of this report is to assess the outcomes of combined femoral and acetabular reconstruction in this population.
  
  
  METHODS
  This study is a retrospective review of all patients with unilateral CP, Gross Motor Function Classification System types I and II, who had hip reconstruction for unilateral dysplasia between 1989 and 2013. Clinical variables (pain and hip passive range of motion) were reviewed. Hip morphology was assessed radiographically according to Melbourne Cerebral Palsy Hip Classification System. Three-dimensional gait analyses were also reviewed to evaluate the effect of surgery on these patients' gaits.
  
  
  RESULTS
  Twelve patients were included with a mean age at surgery of 14 years (range, 7 to 19 y) and follow-up mean of 4 years (range, 1 to 8 y). Nine hips were improved according to Melbourne Cerebral Palsy Hip Classification System. Migration percentage decreased significantly (P<0.001) from 45% (30% to 86%) to 15% (0% to 28%). Neck shaft angle decreased (P<0.001) from 144 degrees (range, 129 to 156 degrees) to 125 degrees (range, 114 to 139 degrees). Tonnis angle and Sharp angle also decreased significantly. All patients were pain free at the last visit. Overall level of gait function as measured by Gait Deviation Index and Gait Profile Score [78 (61 to 89) and 12 (8 to 16), respectively] for all patients was maintained without significant changes.
  
  
  CONCLUSIONS
  In hemiplegic type IV CP, with high functional level (Gross Motor Function Classification System I and II), hip dysplasia is a rare occurrence during adolescent years. Combined hip reconstruction improves hip morphology, relieves pain, and maintains a high level of function.
  
  
  METHODS
  Level IV-therapeutic study.
authors.affiliation: Department of Orthopedics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE.
authors.forename: Oussama
authors.initials: O
authors.lastname: Abousamra
authors.forename: Mehmet S
authors.initials: MS
authors.lastname: Er
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Rogers
authors.forename: Tristan
authors.initials: T
authors.lastname: Nishnianidze
authors.forename: Kirk W
authors.initials: KW
authors.lastname: Dabney
authors.forename: Freeman
authors.initials: F
authors.lastname: Miller
mesh_terms: D000293:Adolescent; D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D002547:Cerebral Palsy / Q000150:complications* / Q000503:physiopathology; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D005684:Gait; D006617:Hip Dislocation / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult