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Scientific Articles   |    
Subtrochanteric Valgus Osteotomy for Chronically Dislocated, Painful Spastic Hips
Kathleen A. Hogan, MD1; Mathew Blake, BS1; Richard H. Gross, MD1
1 Department of Orthopaedic Surgery, Medical University of South Carolina, 96 Jonathan Lucas Street, Suite 708, Charleston, SC 29425. E-mail address for K.A. Hogan: hogan@musc.edu
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The authors did not receive grants or outside funding in support of their research for or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.
Investigation performed at the Department of Orthopaedic Surgery, Medical University of South Carolina, Charleston, South Carolina

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2006 Dec 01;88(12):2624-2631. doi: 10.2106/JBJS.E.00918
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Abstract

Background: Many treatments have been proposed for a painful chronically dislocated hip in a child with spasticity who is unable to walk. The valgus subtrochanteric femoral osteotomy was originally described as a treatment for a missed congenital hip dislocation in a young adult who was able to walk. The purpose of this study was to investigate the outcomes of a modified Hass subtrochanteric valgus osteotomy for the treatment of symptomatic chronic hip dislocations in patients with spasticity due to neuromuscular disorders.

Methods: Patients were identified by surgical codes. Medical records were reviewed for surgical indications, complications, and results. Preoperative and postoperative radiographs were assessed. Caregivers were contacted and asked to complete a brief survey detailing the pain that the patient experienced with daily activities before and after surgery as well as other information.

Results: Thirty-one Hass osteotomies in twenty-four consecutive patients were performed by one surgeon between 1995 and 2005. Although fifteen patients (63%) had at least one complication (including urinary tract infection, pneumonia, hardware failure, and heterotopic bone formation), the majority of the patients were doing well at an average of forty-four months postoperatively. The duration for which the patient could sit, ease of transfers, and ease of diaper changes had all improved according to the caregivers. Fourteen of fifteen caregivers who replied to the question stated that they were satisfied with the operative results and would have the procedure done again if they had the decision to make.

Conclusions: The modified Hass osteotomy provides children who have symptomatic hip dislocations due to neuromuscular disorders with reproducible pain relief and improves ease of positioning by their caregivers. The complication rate, although high, was comparable with that of similar surgical procedures in this patient population. Concurrent femoral head resection at the time of the proximal femoral osteotomy was not necessary in this group of patients.

Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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