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Is arthrodesis the end in spastic hip disease?
P M M B Fucs1, C Svartman, R M C Assumpção
1Neuromuscular Clinic, Department of Orthopaedics and Traumatology, Santa Casa Medical School and Hospitals, São Paulo, Brazil. patricia@fucs.com.br
Introduction:
The purpose of this study was to evaluate the long term results of 19 painful dislocated hips in patients with spastic cerebral palsy (CP) who were treated with hip arthrodesis and internal fixation.
Patients And Methods:
The study included 19 patients with spastic CP with a mean age of 17 years and five months (min 10+11 and max 30+8) at the time of surgery. There were 11 tetraplegics, 5 diplegics, 2 diplegics with athetosis, and one hemiplegic. Functionally, 4 patients were community ambulators, 2 were household, and 13 were non-ambulators. Six patients had previous hip procedures prior to arthrodesis. The main surgical indications were pain and too much joint destruction to reconstruct the hip. The mean follow-up period was 11 years and one month.
Results:
All patients showed bone union and pain relief, and postural improvement was seen in almost all patients. Four patients needed revision, with implant change and bone graft for delayed union. In two cases, the hip arthrodesis ended up being converted into a Castle procedure due to difficulties in positioning and/or increasing spinal deformity.
Conclusion:
Hip arthrodesis is a reasonable option in treating painful spastic subluxated and dislocated hips in CP, primarily in unilateral cases and in patients with ambulatory ability.
