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
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
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
LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions
to Authors for a complete description of levels of evidence.
ORIGINAL ABSTRACT CITATION: "Subtrochanteric Valgus Osteotomy for
Chronically Dislocated, Painful Spastic Hips"