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[Complex reconstruction of subluxated and dislocated hip joints in spastically handicapped children]
Insights
Surgical hip reconstruction in children with cerebral palsy effectively stabilizes dislocated or subluxated joints, leading to painless hips and improved symmetry. This procedure positively impacts psychomotor development and daily care for affected children.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Cerebral palsy research
Background:
- Cerebral palsy (CP) frequently causes hip joint instability, including subluxation and dislocation.
- Hip instability in CP can lead to pain, functional limitations, and secondary deformities.
- Surgical intervention aims to correct hip alignment and improve outcomes in children with CP.
Purpose of the Study:
- To evaluate the efficacy of surgical hip reconstruction in achieving stable, painless hip reduction in children with cerebral palsy (CP).
- To assess the influence of successful hip reconstruction on psychomotor development, trunk and pelvic symmetry, and daily hygiene in children with CP.
Main Methods:
- A complex hip reconstruction technique was applied to 30 hip joints in 26 children with CP.
- A cohort of 17 operated hip joints in 15 children with a minimum 3-year follow-up was retrospectively analyzed.
- Data collection included clinical examinations, radiographic assessments (pelvic anteroposterior and lateral views), and parent/physiotherapist questionnaires.
Main Results:
- Preoperatively, all evaluated hips were decentered, subluxated, or dislocated.
- At a minimum 3-year follow-up, 15 out of 17 operated hip joints remained persistently reduced.
- Significant improvements were observed in radiographic parameters, including the CE angle, AC angle, and neck shaft angle.
Conclusions:
- Surgical reconstruction of decentered hip joints in children with cerebral palsy can achieve stable reduction and pain relief in the mid-term.
- Achieving symmetrical hip joint alignment is crucial for improving pelvic and spinal symmetry.
- Successful hip reconstruction may positively contribute to psychomotor development in children with cerebral palsy.
Question:
Will surgical reconstruction of subluxated or dislocated hip joints in children with cerebral palsy lead to stable reduction and painless hips? Is there any positive influence on psychomotoric development of the children and on trunk and pelvic symmetry as well as on daily hygienic care after successful reduction of unstable hip joints in spastic children?
Materials And Methods:
Thirty hip joints in 26 children with cerebral palsy were operated applying the same complex reconstruction method of the hip joint. Fifteen of these children with 17 operated hip joints fulfilled a minimum follow up period of 3 years were evaluated continuously in this study. The parents and physiotherapists answered a questionnaire, all patients were examined clinically and pelvic anteroposterior and lateral radiographs were obtained.
Results:
The mean age at surgery was 6 years, the minimum follow up 3 years (3-10 years). All hip joints were preoperatively decentered, 6 subluxated, 11 complete dislocated. At follow-up 15 of 17 were persistently reduced. The postoperative results were graded by the parents as excellent and good in eleven, satisfying in four and in two patients as poor. The radiographic evaluation showed an significant improvement of the CE-, AC- and neck shaft angle.
Conclusion:
Reconstruction of decentered hips will lead to stable reduction and painless hips at least in mid term follow-up. Symmetrically centered hip joints are mandatory for a pelvic and spinal symmetry and may contribute for an optimal of psychomotoric development.