Proximal femoral diaphysectomy in cerebral palsy

A study was conducted to evaluate the outcome of massive proximal femoral shortening in the cerebral palsy patient with severe spastic quadriplegia and hip instability. A retrospective review of 13 children (age range: three to 19 years of age) representing 18 hips treated with massive shortening of the proximal femur was conducted. Bilateral procedures were performed in five patients. All procedures were performed between February 1986 and March 1990. Radiographs were evaluated for preoperative and postoperative migration percentage (MP) and femoral neck-shaft angle (NSA). Charts were reviewed for complications and clinical results. All femoral osteotomies healed without difficulty. Clinical follow-up averaged 27.6 months. Satisfactory results occurred in all but one hip. Radiographs taken an average of 19.5 months postoperatively showed improved MP in all but one hip. The average preoperative MP was 70% and postoperative MP was 18%. Femoral NSA also was improved. Heterotopic bone formed in 13 hips but caused no significant problems. Other complications included postoperative seizure, urinary tract infection, cast sores, transient arm weakness, weight loss, pin protrusion through skin, and femur fracture after cast removal. Based on the good results and minimal complications in this series, massive femoral shortening appears to be a superior alternative to proximal femoral resection in these difficult patients.