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The severely unstable hip in cerebral palsy. Treatment with open reduction, pelvic osteotomy, and femoral osteotomy with shortening
L Root; FJ Laplaza; SN Brourman; DH Angel
J Bone Joint Surg Am, 1995 May 01;77(5):703-712
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Abstract

The results in thirty-one patients with cerebral palsy who had a total of thirty-five severely subluxated or dislocated hips were analyzed retrospectively a mean of seven years after open reduction, pelvic osteotomy, varus rotational osteotomy, and femoral shortening. Preoperatively, twenty-two patients had been unable to stand and thirteen had had pain; the mean acetabular index was 50 degrees, the mean center-edge angle was -19 degrees, and the mean migration index was 74 percent. At the latest follow-up examination, none of the hips were painful. Seven patients had an improvement of one level in their walking ability. All of the patients who were confined to a wheelchair had better sitting balance. The mean acetabular index was 40 degrees, the mean center-edge angle was 18 degrees, and the mean migration index was 25 percent. Four hips were subluxated (two of them posteriorly). One hip was treated with a repeat varus rotational osteotomy. Another hip, which was not dislocated, had a rotational osteotomy for excessive femoral anteversion. Eight femoral heads displayed signs of avascular necrosis. One tibial and two femoral fractures occurred after the cast was removed. Three of the four patients who had a subluxated hip had scoliosis. The combined approach improved coverage of the femoral head and decreased pain in the hip. Even though this procedure can be accompanied by serious complications, we believe that the results justify this extensive approach in these patients.

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    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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