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[Long-term results of reconstructive surgery in infantile cerebral palsy patients with high hip dislocation: is hip
F Braatz1, A Eidemüller, M C Klotz
1Abteilung Orthopädie, Klinik für Unfallchirurgie und Orthopädie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland, braatz@pfh.de.
Insights
Early screening programs for children with infantile cerebral palsy (ICP) can help prevent hip dislocations and avoid revision surgeries. Proactive neuro-orthopedic treatment is crucial for better outcomes in managing hip displacement in ICP patients.
Area of Science:
- Orthopedics
- Pediatrics
- Neurology
Context:
- Hip dislocation is a common complication in children with infantile cerebral palsy (ICP), often leading to pain and functional limitations.
- Current management often involves surgical intervention, making the study of the natural course of neurogenic hip displacement challenging.
Purpose:
- To evaluate the effectiveness of surgical reconstruction for high-grade hip dislocation in ICP patients and assess the potential of screening programs to prevent revision procedures.
Summary:
- This study followed 68 children (out of 96 initially included) with Tönnis grade IV hip dislocation, with a mean age of 10.9 years at surgery and a 7.7-year follow-up.
- Postoperative redislocation occurred in 6 out of 91 reconstructed hips, with one patient requiring proximal femoral resection. The mean migration index was 14.0%.
Impact:
- Implementing screening programs can help avoid painful neurogenic hip displacement and the need for revision surgeries like osteotomy or femoral resection.
- Intensifying interdisciplinary collaboration among neuropediatricians, social pediatricians, and neuro-orthopedists is recommended for optimal treatment planning and improved patient outcomes.
Background:
Hip dislocation as a result of neurogenic hip displacement is a common focal motor symptom in children with infantile cerebral palsy (ICP). In addition to contracture of the hip joint, in up to 65 % of cases patients suffer from pain which leads to further loss of function and often to limitations in important basic functions, such as lying, care, sitting, standing and transfer.
Methods:
In order to avoid hip dislocation and to be able to implement therapy at an early stage, screening programs have been developed in recent years which clearly demonstrate the risks of hip displacement in ICP depending on the ability to walk. An investigation of the natural course is practically impossible because as a rule patients with painful neurogenic hip displacement receive surgical therapy.
Patients:
In this study 96 patients with high hip dislocation grade IV on the Tönnis classification were included and 68 could be followed up. The average age at the time of surgery was 10.9 years and the mean follow-up period was 7.7 years. In the postoperative course 6 out of 91 reconstructed hips became redislocated and a proximal femoral resection was carried out in one female patient. The migration index according to Reimers was 14.0 % at the time of the follow-up examination.
Conclusion:
Revision procedures can be avoided by screening programs. These should be strived for so that the neuro-orthopedic treatment on operation planning is not first initiated when pain occurs and revision procedures, such as angulation osteotomy or proximal femoral resection can be avoided. The reconstruction should also involve minimal deformation of the femoral head. In order to implement this, the interdisciplinary cooperation between neuropediatricians, social pediatriatricians and neuro-orthopedists should be intensified in the future.
