Multilevel surgery improves gait in spastic hemiplegia but does not resolve hip dysplasia

Multilevel orthopaedic surgery may improve gait in Type IV hemiplegia, but it is not known if proximal femoral osteotomy combined with adductor release as part of multilevel surgery in patients with hip dysplasia improves hip development.

We asked whether varus derotational osteotomy of the proximal femur, combined with adductor release, influenced hip development in patients with Type IV hemiplegia having multilevel surgery.

We retrospectively reviewed 11 children and adolescents with Type IV hemiplegia who had a proximal femoral osteotomy due to unilateral hip displacement to correct gait dysfunction between 1999 and 2006. The mean age at the time of surgery was 11.1 years (range, 7 to 16 years). We obtained the Movement Analysis Profile and Gait Profile Score before and after surgery. We also measured the Migration Percentage of Reimers and applied the Melbourne Cerebral Palsy Hip Classification System (MCPHCS). The minimum followup was 2 years 3 months (mean, 6 years 6 months; range, 2 years 3 months to 10 years 8 months).

The majority of gait parameters improved but hip development was not normalized. According to the MCPHCS at last followup, no hips were classified as Grade I, two hips were classified as Grade II, and the remainder were Grade III and IV.

Unilateral surgery including a proximal femoral osteotomy improved gait and walking ability in individuals with spastic hemiplegic cerebral palsy. However, hip dysplasia persists.

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.