title: A Modification to the McHale Procedure Reduces Operative Time and Blood Loss.
abstract: BACKGROUND
  Treatment of symptomatic spastic hip dislocations in adolescent patients with cerebral palsy includes a variety of described salvage type procedures. In 1990, McHale and colleagues described a technique involving a femoral head resection, valgus-producing proximal femoral osteotomy, and advancement of the lesser trochanter into the acetabulum. We have modified this technique in 3 ways by: performing it in the lateral position with a more posterior approach, not advancing the lesser trochanter into the acetabulum, and closing the capsule over the acetabulum. The purpose of this paper is to describe our technique and to compare the results to Castle type procedures and McHale procedures performed as originally described.
  
  
  METHODS
  We retrospectively reviewed all salvage type procedures performed at our institution for spastic hip dislocations in children with cerebral palsy from 2003 to 2013. Preoperative and postoperative pain, estimated blood loss, operative time, length of stay in the hospital, and postoperative pelvis radiographs were reviewed for heterotopic ossification formation and proximal femoral migration.
  
  
  RESULTS
  Twenty-six patients with 30 hip procedures were reviewed. The modified McHale technique had shorter operative times when compared with the supine McHale technique and the Castle procedure (134, 171, and 139 min, respectively). There was a trend toward less blood loss in the modified McHale technique, but this was not significant. There was no difference in length of stay in the hospital. The majority of McHale patients (>63%) had pain relief postoperatively, where half of the Castle patients required a revision surgery for pain (4 of 8). There was less heterotopic ossification seen in the modified McHale technique (6.25%) when compared with supine McHale and Castle techniques (both 50%). However, there was more proximal femoral migration in the modified McHale group.
  
  
  CONCLUSIONS
  The modified McHale technique is faster with otherwise equivocal results in the immediate operative periods. There is less heterotopic bone formation but more proximal femoral migration with this new technique.
  
  
  METHODS
  Level IV-case series.
authors.affiliation: *Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, CA †Department of Orthopaedics, University of New Mexico School of Medicine ‡Department of Orthopaedics and Rehabilitation, Carrie Tingley Hospital, University of New Mexico School of Medicine, Albuquerque, NM.
authors.forename: Jenna
authors.initials: J
authors.lastname: Godfrey
authors.forename: Jessica
authors.initials: J
authors.lastname: McGraw
authors.forename: Antony
authors.initials: A
authors.lastname: Kallur
authors.forename: Selina
authors.initials: S
authors.lastname: Silva
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Szalay
mesh_terms: D000077:Acetabulum / Q000601:surgery; D000293:Adolescent; D016063:Blood Loss, Surgical; D002547:Cerebral Palsy / Q000150:complications / Q000503:physiopathology; D002648:Child; D005260:Female; D005269:Femur / Q000601:surgery; D005270:Femur Head / Q000601:surgery*; D006617:Hip Dislocation / Q000150:complications / Q000601:surgery*; D006621:Hip Joint / Q000601:surgery; D006801:Humans; D008297:Male; D061646:Operative Time; D009999:Ossification, Heterotopic / Q000000981:diagnostic imaging; D010027:Osteotomy / Q000379:methods*; D010388:Pelvis / Q000000981:diagnostic imaging; D011859:Radiography; D012086:Reoperation; D012189:Retrospective Studies