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Published on: September 7, 2022
Early results of one-stage correction for hip instability in cerebral palsy
Hui Taek Kim1, Jae Hoon Jang, Jae Min Ahn
1Department of Orthopaedic Surgery, Pusan National University Hospital, Busan, Korea. kimht@pusan.ac.kr
Insights
One-stage correction surgery effectively treats hip dislocation in children with cerebral palsy (CP). This procedure improves hip function, mobility, and patient comfort while showing positive radiological outcomes.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Cerebral palsy management
Background:
- Cerebral palsy (CP) often leads to hip dysplasia and dislocation.
- Current treatments may involve multiple surgical stages.
Purpose of the Study:
- To evaluate the clinical and radiological outcomes of a one-stage surgical correction for hip dislocation in children with cerebral palsy.
Main Methods:
- Retrospective review of 32 hips in 23 children with CP undergoing one-stage surgery.
- Procedures included open reduction, muscle release, femoral osteotomy, and modified Dega osteotomy.
- Clinical (hip range of motion, GMFCS level, comfort, pain) and radiological (acetabular index, center-edge angle, migration percentage) outcomes were assessed pre- and post-operatively.
Main Results:
- Significant improvements were observed in hip abduction, sitting comfort, and Gross Motor Function Classification System (GMFCS) levels.
- Post-operative pain decreased.
- All measured radiological indices showed improvement.
- Two cases of femoral head avascular necrosis occurred; no infections, nonunions, resubluxations, or redislocations were reported.
Conclusions:
- Single-event multilevel surgery combining soft tissue, pelvic, and femoral corrections is effective for treating spastic hip dislocation in cerebral palsy.
- This approach offers a viable option for improving hip function and stability in this patient population.
Background:
We evaluated the clinical and radiological results of one-stage correction for cerebral palsy patients.
Methods:
We reviewed clinical outcomes and radiologic indices of 32 dysplastic hips in 23 children with cerebral palsy (13 males, 10 females; mean age, 8.6 years). Ten hips had dislocation, while 22 had subluxation. Preoperative Gross Motor Function Classification System (GMFCS) scores of the patients were as follows; level V (13 patients), level IV (9), and level III (1). Acetabular deficiency was anterior in 5 hips, superolateral in 7, posterior in 11 and mixed in 9, according to 3 dimensional computed tomography. The combined surgery included open reduction of the femoral head, release of contracted muscles, femoral shortening varus derotation osteotomy and the modified Dega osteotomy. Hip range of motion, GMFCS level, acetabular index, center-edge angle and migration percentage were measured before and after surgery. The mean follow-up period was 28.1 months.
Results:
Hip abduction (median, 40°), sitting comfort and GMFCS level were improved after surgery, and pain was decreased. There were two cases of femoral head avascular necrosis, but no infection, nonunion, resubluxation or redislocation. All radiologic indices showed improvement after surgery.
Conclusions:
A single event multilevel surgery including soft tissue, pelvic and femoral side correction is effective in treating spastic dislocation of the hip in cerebral palsy.
