[Surgical treatment of secondary hip dislocation in cerebral palsy]

The surgical treatment of secondary dislocation of the hip is one of the most challenging issues in cerebral palsy. The selection and application of adequate surgical techniques require an outstanding knowledge of pathophysiology in order to achieve a good outcome with minimal operative expenditure. The hips of cerebral palsied children show no pathological findings at birth. The dislocation of the hip is a secondary process, due to the influence of permanently deteriorating muscle dysbalances that first cause a decentration and finally result in a complete dislocation. Physiotherapeutic treatment supports the development of gait, muscle balance and weight bearing in the early childhood, however, severe hip dislocation can not be prevented with physiotherapy alone. Surgical treatment aims to prevent hip dislocation in order to maintain the ability to walk and to sit, and to avoid secondary skin ulcers. Soft tissue release is performed to neutralize muscle dysbalances. Progressive dislocation requires extended surgical treatment. The combination of soft tissue release, varisation osteotomy and acetabular osteotomy enable an adequate repositioning of the hip and have proved to preserve hips from reluxation. Palliative operations including soft tissue release in combination with angulation osteotomy, and proximal femoral head resection are restricted to failed reconstruction operations or severe luxations, and are performed to attempt pain reduction or the facilitation of perineal care. Surgical planning distinguishes patients able to walk from those who are unable to walk or to sit without support. The manifestation of cerebral palsy and the aim of adequate pain reduction and the maintenance of statomotoric abilities also have a great impact on surgical planning. The treatment of secondary hip dislocation in cerebral palsy is facilitated by the use of a graduated treatment concept with early preventive soft tissue release, extended reconstruction and optional palliative care.