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[Surgical treatment of hip dislocation in patients with infantile cerebral palsy]
C Carstens1, F U Niethard, M Schwinning
1Abteilung für Orthopädie im Kindesalter Stiftung Orthopädische Universitätsklinik, Heidelberg.
Insights
Surgical hip correction in cerebral palsy patients achieved permanent hip stability. Procedures like pelvic osteotomy improved motor function in diplegic patients and prevented hip pain in tetraplegic individuals.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Cerebral Palsy Research
Background:
- Cerebral palsy (CP) frequently causes hip subluxation or dislocation.
- Surgical intervention is crucial for managing hip instability in CP patients.
- Previous studies highlight the need for effective surgical techniques.
Purpose of the Study:
- To review the outcomes of hip reconstructive surgery in cerebral palsy patients.
- To evaluate the effectiveness of combined surgical procedures for hip stability.
- To assess functional improvements and long-term benefits in different CP types.
Main Methods:
- Retrospective review of 63 hip operations on 52 cerebral palsy patients (1978-1988).
- Procedures included innominate pelvic osteotomy, intertrochanteric femoral osteotomy, and soft tissue release.
- Analysis of pre- and post-operative hip joint stability, CE-angle, and acetabular index.
Main Results:
- Combined surgical procedures successfully achieved permanent hip joint stability in most cases.
- Acetabular remodeling was observed after adequate femoral head reduction.
- Diplegic patients showed significant motor activity improvement; tetraplegic patients benefited from pain prevention and improved care conditions.
Conclusions:
- Combined surgical interventions, including pelvic and femoral osteotomies, are effective for hip stability in cerebral palsy.
- Acetabular remodeling indicates the potential for long-term joint health.
- Functional gains vary by CP type, emphasizing the importance of tailored surgical goals.
Abstract:
The results of 63 operations on 52 patients with cerebral palsy, which were performed between 1978 and 1988 to correct a subluxation or dislocation of the hip, were reviewed. The innominate pelvic osteotomy was preferably combined with intertrochanteric femoral osteotomy and soft tissue release. The average age at time of surgery was 7 years/2 months. Surgical intervention was indicated irrespective of the severity of neurologic involvement. The mean follow-up period is 3 years/4 months. The results show, that by a combinations of these surgical procedures a permanent stability of the hip joint can be achieved. Retrospectively the 5 cases of reluxation can be explained by insufficient surgical technique. The postoperative development of the CE-angle and the acetabular index reveal, that after adequate reduction of the femoral head the acetabulum is able to remodel its dysplasia. From a functional point of view actually patients with diplegia gained the most benefit from a stable hip joint, because they showed the most progress in motor activity. In tetraplegic patients the long-term success of these surgical procedures must be seen in the prevention of a painful hip in adult life, the maintenance of sitting-stability and the improvement of perineal care condition.