Developmental dysplasia of the hip in cerebral palsy--surgical treatment

Developmental dysplasia of the hip (DDH) in cerebral palsy (CP) is very rare, and very little clinical data is available. We have analysed the results of open reduction of the hip (Howorth), acetabuloplasty (Salter, Pemberton), pelvic osteotomy (Chiari) and femoral osteotomy in the treatment of the DDH in CP patients. Radiographic assessment was based on the Severin grading classification system and measurements of migration percentage (MP) before and after surgery. Clinical results were analysed using the Ponsetti classification system in ambulatory patients. A total of 45 hips in 31 patients were treated surgically. The average age of the patients was 5.2 years (range: 2-16 years). The average follow-up was 9.6 years (range: 3-28 years). Analysis of the radiographic results according to Severin placed 35 hips (77.8%) in groups 1 and 2 and ten hips (22.2%) in groups 3 and higher. The average preoperative MP value was 78.7% and the average postoperative MP was 15.2%. Redislocation occurred in three hips. Clinical results were disappointing: based on Ponsetti assessment 14 hips (36.8%) were classified in the first three groups and 24 hips (63.2%) in the last three groups. This analysis suggests that these surgical procedures could be applied in treating DDH in CP.