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Established hip dislocations in children with cerebral palsy
J G Gamble1, L A Rinsky, E E Bleck
1Stanford University School of Medicine, Children's Hospital, Palo Alto, CA 94304.
Insights
Hip dislocation in children with cerebral palsy is often due to muscle imbalance and hip structure issues. Combined surgical procedures offer the most successful outcomes for hip reduction in these patients.
Area of Science:
- Orthopedic Surgery
- Pediatric Neurology
- Rehabilitation Medicine
Background:
- Hip dislocation is a common complication in children with cerebral palsy (CP).
- Factors contributing to dislocation include spastic muscle imbalance, abnormal femoral geometry, acetabular dysplasia, and contractures.
- Prevalence approaches 50% in spastic quadriplegic children, correlating with spasticity severity.
Purpose of the Study:
- To identify the primary causes of hip dislocation in pediatric cerebral palsy patients.
- To evaluate the effectiveness of different surgical interventions for hip reduction.
- To determine the optimal surgical approach for achieving successful hip reduction and coverage.
Main Methods:
- Review of 31 hip dislocation cases in 24 pediatric cerebral palsy patients.
- Analysis of contributing factors: spasticity, femoral geometry, dysplasia, and contractures.
- Evaluation of surgical outcomes following various reduction procedures.
Main Results:
- Successful hip reductions were associated with improved muscular balance, satisfactory femoral head reduction, and good pelvic coverage.
- Combined surgical procedures demonstrated the highest success rates.
- The most effective combined procedure involved soft-tissue release, open reduction, femoral osteotomy, and pelvic osteotomy.
Conclusions:
- Hip dislocation in cerebral palsy is multifactorial, with spasticity severity being a key indicator.
- Combined surgical interventions, including osteotomies and soft-tissue release, are crucial for successful hip reduction.
- Achieving stable hip reduction and adequate pelvic coverage is vital for functional improvement in these patients.
Abstract:
Hip dislocation in children with cerebral palsy is caused by a combination of factors, including spastic muscle imbalance, persistent fetal femoral geometry, acetabular dysplasia, and flexion-adduction contracture. The incidence of dislocation correlates with the severity of the spasticity, and the prevalence is close to 50% in neurologically immature, spastic quadriplegic children. Successful hip reductions improve muscular balance, provide satisfactory reduction of the femoral head, and establish good pelvic coverage. In 31 occurrences of established hip dislocation in 24 patients, the most successful operations used a combined procedure consisting of soft-tissue release, open reduction, femoral varus derotation and shortening osteotomy, and pelvic osteotomy.
