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One-stage hip reconstruction in children with cerebral palsy: long-term results at skeletal maturity
Cindy Mallet1, B Ilharreborde, A Presedo
1Pediatric Orthopedic Department, Robert Debre University Hospital, Paris Diderot University, 48 bd Serurier, 75019, Paris, France, mallet_cindy@yahoo.fr.
Insights
This study evaluated a surgical technique for hip subluxation in children with cerebral palsy (CP). While effective for acetabular dysplasia, valgus deformity recurrence impacts long-term hip stability.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Cerebral palsy research
Background:
- Hip subluxation is a frequent complication in children with cerebral palsy (CP).
- Surgical intervention is typically reserved for cases involving pain or progressive radiographic signs of instability.
- The long-term efficacy of combined peri-iliac and femoral osteotomies for CP hip subluxation requires further elucidation.
Purpose of the Study:
- To assess the long-term radiological outcomes of Dega acetabuloplasty combined with femoral osteotomy in children with cerebral palsy.
- To evaluate the stability of acetabular and femoral correction at skeletal maturity.
- To determine the effectiveness of this surgical approach in managing hip dysplasia in CP.
Main Methods:
- Retrospective analysis of 20 hips in 20 children with CP who underwent Dega acetabuloplasty and femoral osteotomy.
- Radiographic measurements including Reimers index, acetabular angle (AA), and neck-shaft angle (NSA) were compared preoperatively, postoperatively, and at skeletal maturity.
- Mean follow-up duration was 9.1 years, with patients evaluated at skeletal maturity.
Main Results:
- Dega acetabuloplasty significantly improved the acetabular angle (AA), with corrections remaining stable at maturity.
- A significant postoperative decrease in the neck-shaft angle (NSA) was observed, but recurrence of proximal femur valgus deformity was noted at maturity.
- Despite valgus recurrence, 90% of hips maintained >70% coverage at skeletal maturity; one hip dislocated and one subluxated.
Conclusions:
- The one-stage surgical procedure effectively corrected acetabular dysplasia in children with CP.
- Progressive recurrence of proximal femur valgus deformity, linked to spasticity and muscle weakness, led to increased Reimers index.
- The technique demonstrated successful treatment of neurological hips, maintaining adequate coverage despite some late instability.
Purpose:
Hip subluxation is common in children with cerebral palsy (CP). Surgery is indicated in case of pain or progressive increase of Reimers index on radiographs. Peri-iliac osteotomy combined with femoral osteotomy is one of the numerous operative techniques available, but results at skeletal maturity remain unclear. The purpose of this radiological study was to report the long-term results of this procedure.
Materials And Methods:
Twenty hips in 20 children were retrospectively evaluated at skeletal maturity. Mean age at surgery was 8.1 years and follow-up averaged 9.1 years. All patients underwent Dega acetabuloplasty, soft-tissue release and femoral-shortening varus derotation osteotomy without open reduction. Reimers index, acetabular angle (AA) and neck-shaft angle (NSA) were compared on preoperative, postoperative and latest follow-up radiographs.
Results:
Dega osteotomy significantly improved the AA and the correction remained stable at maturity. The NSA significantly decreased postoperatively (153°-115°), but recurrence of the valgus deformity (130°) of the proximal femur was observed at maturity. Consequently, Reimers index followed the same evolution. No case of osteonecrosis was reported but one hip dislocated and one subluxated during follow-up.
Conclusion:
Progressive recurrence of the valgus deformity of the proximal femur, attributable to adductors spasticity and gluteus medius weakness, led to a significant increase in the Reimers index. However, hip coverage remained >70 % at maturity in 90 % of the hips. This one-stage procedure without hip dislocation efficaciously corrected acetabulum dysplasia and successfully treated neurological hips in CP patients.
Level Of Evidence Iv:
retrospective study.
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