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Our approach to the spastic hip subluxation and dislocation in children with cerebral palsy
Pavel Sponer1, David Pellar, Tomás Kucera
1Charles University in Prague, Faculty of Medicine in Hradec Králové and University Hospital Hradec Králové, Czech Republic. sponer.p@seznam.cz
Insights
Surgical interventions for spastic hip subluxation and dislocation in children with cerebral palsy improved hip function and range of motion. Musculoskeletal treatment in childhood is crucial for preventing long-term pain and deformity.
Area of Science:
- Pediatric Orthopedics
- Cerebral Palsy Research
- Musculoskeletal Disorders
Background:
- Spastic hip subluxation and dislocation are common complications in children with cerebral palsy.
- Early intervention is critical to optimize function and prevent long-term musculoskeletal issues.
Purpose of the Study:
- To evaluate the effectiveness of surgical approaches for spastic hip subluxation and dislocation in pediatric cerebral palsy patients.
- To assess outcomes of soft-tissue release, osseous reconstructive, and palliative surgeries.
Main Methods:
- Retrospective review of 56 hips in children with cerebral palsy undergoing surgery between 2003-2005.
- Surgical procedures included soft-tissue release (42 hips), osseous reconstructive surgery (11 hips), and osseous palliative surgery (3 hips).
- Follow-up duration ranged from 1 to 3 years post-surgery.
Main Results:
- Soft-tissue release yielded good results in 15 hips, fair in 15, poor in 9, and failure in 3.
- Osseous surgery demonstrated no redislocations.
- Osseous palliative surgery resulted in no pain in 2 patients and transient pain in 1; all hips showed increased range of motion (abduction).
Conclusions:
- Surgical management of spastic hip subluxation/dislocation in cerebral palsy can improve hip function, range of motion, and rehabilitation potential.
- Early musculoskeletal intervention in childhood is vital for maximizing functional outcomes and preventing future pain and deformities.
- Various surgical techniques offer different outcomes, highlighting the need for tailored treatment approaches.
Abstract:
The purpose of this study was to evaluate the effectiveness of our approach to the spastic hip subluxation and dislocation in children with cerebral palsy. We evaluated 56 hips in our consecutive patients who had been operated on at our department between January 2003 and December 2005. There were done soft-tissue release procedures in 42 hips, osseous reconstructive surgery in 11 hips and osseous palliative surgery in 3 hips. The duration of follow-ups was 1-3 years after surgery. We achieved good result in 15 hips after soft-tissue release, fifteen hips had a fair result, nine a poor result and three a failure. No redislocation was observed after osseous surgery in our patients. Two patients observed no pain after osseous palliative surgery, transient pain in the hip was in one case. In all hips the range of motion (abduction) was increased. The personal hygiene and possibilities of rehabilitation were improved. Childhood is the optimal time to intervene to maximize the function of the patient with cerebral palsy. The musculoskeletal treatment of the child prevents future problems with pain and deformity.