Proximal femoral resection-interposition arthroplasty in cerebral palsy

Hip dislocation is common in children with total body cerebral palsy. It is associated with pain, difficulty in seating and problems with perineal hygiene. We present a retrospective study of 15 patients who had undergone 21 proximal femoral resection-interposition arthroplasties between 1990 and 2005. The mean age at the time of surgery was 16.2 years (range 11-26 years). Mean follow-up was 3.4 years (range 1-7 years). Ninety percent of patients had pain relief. Perineal hygiene and sitting was improved in all cases. A lateral femoral head defect was noted in 90% of hips and was associated with pain, and significant degenerative changes. Twelve hips had heterotopic ossification (11 type-1, one type-2 and 0 type-3). No major complications were seen. We would submit that proximal femoral resection is a good salvage procedure for the painful, dislocated hip, with an excellent chance of resolving symptoms. The finding of a lateral femoral head defect on the radiograph is associated with significant degenerative changes.