Background: Spastic hip subluxation and dislocation are common
problems in children with cerebral palsy. Soft-tissue releases have proved to
be beneficial in the prevention of spastic hip dislocation. A protocol for
treatment based on patient age, hip abduction, and hip migration percentage
was established in 1988. The purpose of this study was to assess the outcome
in sixty-five children treated according to this protocol and followed for a
minimum of eight years.
Methods: The medical records and radiographs of sixty-five children,
from an original series of seventy-four patients, who met the inclusion
criteria were available for review. Forty-seven children had spastic
quadriplegia and were unable to walk; eighteen children had spastic diplegia
and were able to walk independently or with assistive devices. The mean age at
the time of the surgery was 4.4 years. Open adductor tenotomy and psoas muscle
recession or iliopsoas tenotomy were performed on 129 hips, which were
followed for a mean of 10.8 years. The mean age at the time of follow-up was
fifteen years. Hips were grouped according to the hip migration percentage
preoperatively, at one year postoperatively, and at the time of final
follow-up. The final outcome for the patient was defined according to the
worse hip. An analysis was performed to identify potential factors influencing
Results: Thirty-two patients (49%) had a good result, eleven (17%)
had a fair result, three (4%) had a poor result, and nineteen (30%) had a
failure. The mean hip migration percentage was 34% preoperatively and 18% at
the time of final follow-up. Nineteen patients required subsequent osseous
reconstructive procedures, and eleven required repeat soft-tissue releases.
The migration percentage at one year postoperatively was the most predictive
of the final outcome (p = 0.001). Patients who had been able to walk
preoperatively had a better long-term outcome (p = 0.01). Neither the
preoperative hip migration percentage nor the age at surgery significantly
affected the outcome.
Conclusions: Soft-tissue release was effective for long-term
prevention of hip dislocation in 67% (forty-three) of sixty-five children with
spastic hip subluxation. Two preoperative factors that were related to a
favorable outcome were a spastic diplegic pattern of involvement and the
ability to walk. The hip migration percentage at one year postoperatively was
a good predictor of final outcome.
Level of Evidence: Therapeutic Level IV. See Instructions
to Authors for a complete description of levels of evidence.