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Subtrochanteric valgus osteotomy for chronically dislocated, painful spastic hips.
Kathleen A Hogan1, Mathew Blake, Richard H Gross
1Department of Orthopaedic Surgery, Medical University of South Carolina, 96 Jonathan Lucas Street, Suite 708, Charleston, SC 29425, USA. hogan@musc.edu
The Journal of Bone and Joint Surgery. American Volume
|December 5, 2006
Summary
The modified Hass osteotomy effectively relieved pain and improved positioning for children with spastic hip dislocations. Despite a high complication rate, caregivers reported satisfaction with surgical outcomes.
Area of Science:
- Pediatric Orthopedics
- Neuromuscular Disorders
- Surgical Outcomes
Background:
- Chronic hip dislocations in children with spasticity present significant challenges.
- Traditional treatments are often insufficient for non-ambulatory patients.
- Valgus subtrochanteric osteotomy offers a potential solution for painful hip dislocations.
Purpose of the Study:
- To evaluate the outcomes of a modified Hass subtrochanteric valgus osteotomy.
- To assess its effectiveness in treating symptomatic chronic hip dislocations in spastic patients.
- To analyze pain relief, functional improvement, and complications.
Main Methods:
- Retrospective review of 31 Hass osteotomies in 24 patients (1995-2005).
- Analysis of surgical indications, complications, and radiographic outcomes.
- Caregiver surveys on pre- and post-operative pain and functional status.
Main Results:
- 15 patients (63%) experienced complications (e.g., UTI, pneumonia, hardware failure).
- Majority of patients showed improvement at an average of 44 months post-op.
- Caregivers reported improved sitting duration, transfers, and diaper changes; 14/15 satisfied.
Conclusions:
- Modified Hass osteotomy offers reproducible pain relief and improved positioning for children with spastic hip dislocations.
- High complication rate is comparable to similar procedures in this population.
- Femoral head resection was not necessary concurrently.