Evaluation and treatment of hip joint instability in patients with cerebral palsy

Hip subluxation and dislocation in patients suffering from cerebral palsy (CP) develop in response to a muscle imbalance, caused by contracture of hip adductors and flexors. In the radiological measurement of hip joint instability, the Reimers migration percentage and migration index is used. These methods are useful in planning soft tissue or bony surgery and also for the post operative follow up.

Authors evaluated 15 spastic patients with spastic tetra and di-plegia with 19 dislocated hips who underwent one stage hip reconstruction between 1995-2000. At one stage surgery, adductor tenotomy, capsulotomy, iliopsoas tenotomy, shortening varus (rotation) femoral osteotomy and pelvic osteotomy was performed.

Complete stability was obtained in 16 hips with neither redislocation nor subluxation. The mean MP was 11.5% at the 5 year follow up. In one patient, a bilateral proximal femoral resection due to painful hips was performed later. None of the patients showed evidence of AVN.

Hip instability leading to subluxation or dislocation is a serious problem in children suffering from CP and is usually worse in severe condition. Once subluxation or dislocation occurs, muscle releases should be combined with varus and shortening osteotomy. In an acetabular insufficiency, pelvic osteotomy is necessary to obtain the stability (Tab. 1, Ref 2, Ref 8). Full Text (Free, PDF) www.bmj.sk.