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[Acetabuloplasty in cerebral palsy patients]
1Ortopedická klinika 2. LF UK a FN Motol - Detská a dospelá ortopedie a traumatologie, Praha.
Insights
Acetabuloplasty effectively realigns hip joints in children with cerebral palsy, improving symmetry and coverage without harming hip abductors. This procedure helps avoid more complex surgeries for hip subluxation.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Cerebral palsy management
Context:
- Cerebral palsy often leads to hip joint instability and subluxation.
- Surgical intervention is frequently necessary for hip realignment in these patients.
- Acetabuloplasty offers a reconstructive option for hip joint deformities.
Purpose:
- To evaluate the efficacy of acetabuloplasty as an isolated procedure for hip realignment in cerebral palsy patients.
- To assess clinical and radiographic outcomes of acetabuloplasty in children aged 4-13.
- To determine the impact of acetabuloplasty on hip joint geometry and stability.
Summary:
- Twenty children with cerebral palsy underwent acetabuloplasty, with 21 hips treated.
- Post-operative assessment showed improved hip joint coverage (all hips Group A) and stability.
- One case of recurrent dislocation was managed conservatively; two patients had acetabular migration.
Impact:
- Acetabuloplasty improves hip joint symmetry and coverage in cerebral palsy.
- The procedure is indicated for hip subluxation, alone or with other techniques.
- It avoids more invasive surgeries and preserves hip abductor function.
Purpose Of The Study:
Acetabuloplasty as an isolated surgical procedure is one of the options allowing for hip joint realignment in cerebral palsy patients. Also, it is often involved in combined techniques used for hip joint reconstruction.
Material:
In the years 2004-2005, 20 cerebral palsy patients, aged from 4 to 13 years, were indicated for acetabuloplasty. The group included children with varying degrees of locomotor disability, ranging from inability even to crawl to ability to move without support (stages 2 to 7 on the Vojta scale).
Methods:
Clinical and X-ray findings were evaluated at 2 and 6 months after surgical treatment and then every 6 months of follow- up. The X-ray finding was described by means of CE angle (Wiberg) values and hip migration percentage.
Results:
Of 21 hips (in 20 patients) treated by acetabuloplasty in our modification during the two years, one developed recurrent dorsal dislocation which was possible to deal with by conservative treatment. All hips pre-operatively categorized as group B or group C were post-operatively assessed as group A hips. Subsequent migration of the acetabulum occurred within a year in two patients with distinct original asymmetry.
Discussion:
Surgery on bones comprising the hip joint in cerebral palsy patients is indicated according to the degree of lateral migration and changes in hip joint geometry involving the proximal femur or pelvis, or in combination with open reduction. Acetabuloplasty is indicated as an isolated procedure or as part of combined techniques leading to a better coverage of the hip joint. It is recommended for children up to 10 years of age, but also older ones, in whom the flexibility of child bones enables us to do without internal osteosynthesis.
Conclusions:
Acetabuloplasty is indicated as an isolated surgical procedure for hip joint subluxation in cerebral palsy children. It has no adverse effects on hip abductors that, in cerebral palsy patients, are 85 % insufficient. It improves hip joint symmetry and helps to avoid more demanding reconstructive or palliative procedures. Key words: cerebral palsy, acetabuloplasty, lateral migration.
