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[Spastic hip surgery in children]
Juan Ernesto Zamudio Carrera1, Gustavo Legorreta Cuevas
1Hospital Shriners para Niños, México, D.F. drzamudio@hotmail.com
Insights
Subtrochanteric osteotomy in infantile cerebral palsy can improve hip stability, but recurrence is possible due to spasticity. Combined procedures like cotyloplasty yield better outcomes, especially in younger patients with diplegia or paraplegia.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Cerebral palsy research
Context:
- Infantile cerebral palsy (ICP) frequently causes hip spasticity, leading to subluxation or dislocation.
- Subtrochanteric osteotomy is a surgical option for managing hip deformities in ICP.
- Long-term outcomes of hip surgery in ICP patients require further investigation.
Purpose:
- To evaluate the effectiveness of subtrochanteric osteotomy in treating hip subluxation/dislocation in infantile cerebral palsy.
- To compare outcomes of single osteotomy versus combined procedures (osteotomy with cotyloplasty or soft tissue repair).
- To identify patient factors influencing surgical success.
Summary:
- A retrospective study analyzed 20 ICP patients undergoing hip subtrochanteric osteotomy over 5 years.
- Good outcomes were achieved in 50% of cases; 20% had poor results.
- Younger patients with spastic diplegia and paraplegia showed better results. Osteotomy alone was less effective than combined procedures, with osteotomy plus cotyloplasty showing superior outcomes.
Impact:
- Subtrochanteric osteotomy can yield positive results in managing hip issues in ICP, but spasticity remains a challenge.
- Combined surgical approaches, particularly osteotomy with cotyloplasty, are recommended for better long-term hip stability in ICP.
- This study highlights the importance of tailored surgical strategies based on patient-specific factors like spasticity patterns and age.
Background:
Spasticity in patients with infantile cerebral palsy may lead to progressive subluxation and/or hip dislocation.
Material And Methods:
Retrospective, cross-sectional trial of a cohort of patients with infantile cerebral palsy who underwent subtrochanteric osteotomy of the hip at the Shriner's Hospital for children in Mexico City, with a 5-year follow-up. X-ray evaluation was conducted pre- and postoperatively and at the 5-year follow-up using the Settecerri classification.
Results:
Twenty cases were analyzed; mean age was 8.8 years. They included spastic quadriplegia, spastic diplegia, spastic paraplegia. Good results accounted for 50%, fair 30% and poor 20%. Good results in patients with quadriplegia represented 50%, with diplegia 25%, and with paraplegia 75%. Among patients undergoing single osteotomy, good results were 28%, fair 57%,and poor 14%; among those undergoing osteotomy plus cotyloplasty, good results were 63%, fair 9%, and poor 27%. Results with osteotomy plus soft tissues were good and fair in 50% of patients.
Discussion:
Spasticity and its effects are always present, regardless of surgery, treatment or no treatment; this is the reason for the recurrence of deformities or articular problems of the hip. The benefit of treatment cannot be denied despite spasticity.
Conclusions:
The best results were seen among the youngest patients with spastic diplegia and spastic paraplegia. Osteotomy as a single procedure is insufficient and therefore cotyloplasty is recommended.
