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Effectiveness of two methods of treatment of the spastic hip in CP children
Rafał Piasek1, Sławomir Snela, Bogusław Rydzak
1Department of Paediatric Orthopaedics and Traumatology with Early Paediatric Musculoskeletal Rehabilitation Ward, Regional Hospital No. 2 in Rzeszow, Poland. ewaraf@wp.pl
Insights
Open adductor tenotomy shows promise for improving hip joint stability in children with cerebral palsy (CP). Continuous monitoring of the Reimers index is crucial for predicting outcomes in spastic hips.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Cerebral Palsy Research
Background:
- Cerebral palsy (CP) can lead to hip joint instability.
- Surgical interventions are employed to manage hip complications in CP.
- Evaluating post-operative outcomes is essential for treatment optimization.
Purpose of the Study:
- To compare the effectiveness of two surgical methods for hip joint instability in children with CP.
- To analyze the radiological changes in hip joints post-surgery.
- To assess the impact of surgical interventions on hip stability using the Reimers index.
Main Methods:
- Retrospective analysis of 50 children (100 hips) with CP treated between 1999-2004.
- Division into two groups: open adductor tenotomy versus Gob's method (flexion-adduction contracture release).
- Radiological assessment of hip joint stability using the Reimers index with serial radiographs.
Main Results:
- Open adductor tenotomy group: 70% improvement, 17.5% deterioration, 12.5% no change in Reimers index.
- Gob's method group: 30% improvement, 20% deterioration, 50% no change in Reimers index.
- Significant differences in outcomes between the two surgical approaches were observed.
Conclusions:
- Open adductor tenotomy appears to be an effective surgical option for hip instability in children with CP.
- Regular monitoring of the Reimers index is vital for predicting the progression of spastic hip.
- Further research may refine surgical strategies for managing hip deformities in CP.
Background:
Authors analysed the post-operative course of the hip joints in ICP children following two types of surgery.
Material And Methods:
We analysed 50 children with CP (100 hips) treated in our department between 1999-2004 whose radiological records were complete. The children were divided into 2 groups of those following open adductor tenotomy and those treated according to Gob's method, i.e. by release of the flexion-adduction hip contracture. Hip joint stability was compared radiologically with the Reimers index. Consecutive radiographs were obtained at least 6 months apart and at least two radiographs were obtained in each patient.
Results:
In the first group, the Reimers index improved in 56 hips (70%), deteriorated in 14 hips (17.5%), and did not change in 10 hips (12.5%). In the second group, the index improved in 6 hips (30%), deteriorated in 4 hips (20%), and did not change in 10 hips (50%).
Conclusions:
1. Open adductor tenotomy may be an effective treatment for hip joint instability in cerebrally palsied children. 2. Continual monitoring of the Reimers index is a prerequisite for predicting the natural history of the spastic hip.
