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Bilateral hip surgery in severe cerebral palsy a preliminary review
K L Owers1, J Pyman, M F Gargan
1Department of Orthopaedics and Trauma, Southmead Hospital, Westbury-on-Trym, Bristol, England.
Insights
Bilateral simultaneous hip surgery in children with severe cerebral palsy improved hip movement, containment, and pain relief. This treatment enhanced patient handling and carer satisfaction, regardless of cerebral palsy subtype.
Area of Science:
- Orthopedic surgery
- Pediatric neurology
- Rehabilitation medicine
Background:
- Severe cerebral palsy affecting the entire body often leads to pelvic asymmetry, placing both hips at risk.
- Hip involvement in cerebral palsy can result in pain, limited range of motion, and functional deficits.
Purpose of the Study:
- To evaluate the efficacy of bilateral simultaneous combined soft-tissue and bony hip surgery in children with severe cerebral palsy.
- To assess the impact of surgery on hip range of movement, symmetry, radiological containment, pain, handling, and function.
Main Methods:
- A six-year retrospective clinical, radiological, and functional study.
- Involved 30 children (60 hips) with severe, total-body cerebral palsy.
- Surgical intervention included combined soft-tissue and bony procedures.
Main Results:
- Early results (median 3-year follow-up) showed significant improvements in hip abduction and adduction in flexion.
- Improvements were noted in fixed flexion contracture, radiological hip containment (Reimer's migration percentage, Wiberg's centre-edge angle), and pain relief.
- Patient handling improved, with high carer satisfaction; no difference observed between dystonic and hypertonic groups.
Conclusions:
- Bilateral simultaneous hip surgery is effective in improving hip mechanics and containment in children with severe cerebral palsy.
- The surgical approach positively impacts pain, function, and ease of patient care.
- Outcomes are consistent across different subtypes of cerebral palsy evaluated.
Abstract:
When cerebral palsy involves the entire body pelvic asymmetry indicates that both hips are 'at risk'. We carried out a six-year retrospective clinical, radiological and functional study of 30 children (60 hips) with severe cerebral palsy involving the entire body to evaluate whether bilateral simultaneous combined soft-tissue and bony surgery of the hip could affect the range of movement, achieve hip symmetry as judged by the windsweep index, improve the radiological indices of hip containment, relieve pain, and improve handling and function. The early results at a median follow-up of three years showed improvements in abduction and adduction of the hips in flexion, fixed flexion contracture, radiological containment of the hip using both Reimer's migration percentage and the centre-edge angle of Wiberg, and in relief of pain. Ease of patient handling improved and the satisfaction of the carer with the results was high. There was no difference in outcome between the dystonic and hypertonic groups.
