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Published on: September 7, 2022
Treatment of the Dislocated Hip in Infants With Spasticity
Christian A Refakis1, Keith D Baldwin, David A Spiegel
1Division of Orthopaedic Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA.
Insights
Surgical hip reconstruction in infants with spasticity and hip dislocations shows high success rates. Comprehensive procedures achieved adequate hip reduction in nearly 90% of cases with acceptable complications.
Area of Science:
- Pediatric Orthopedics
- Neuromuscular Diseases
- Hip Surgery
Background:
- Limited data exist on treating infants with both hip dislocations and spasticity.
- Developmental dysplasia of the hip and spastic hip disease are often studied separately.
Purpose of the Study:
- To review surgical treatment outcomes for infants with dislocated hips and underlying spasticity.
Main Methods:
- Retrospective review of children under 3 years with hip reconstruction for dislocated hips due to cerebral palsy or neuromuscular disease.
- Analysis of clinical data, complications, and need for further surgery.
- Radiographic assessment of International Hip Dysplasia Institute (IHDI) grade, acetabular index, and migration percentage.
Main Results:
- 15 hips in 11 infants (mean age 20 months) underwent open reduction, adductor tenotomy, and osteotomies.
- Postoperatively, 86.7% of hips were IHDI grade 1 at a mean follow-up of 40 months.
- Mean acetabular index improved, and no significant osteonecrosis was observed; complications included 2 femur fractures.
Conclusions:
- Open reduction with osteotomies achieves nearly 90% success in hip reduction for infants with spasticity and dislocations.
- Comprehensive hip reconstruction is largely successful with manageable complications in this unique population.
Background:
Although many studies have separately investigated the treatment of developmental dysplasia of the hip and spastic hip disease, little data exist regarding the treatment of infants with dislocated hips and underlying spasticity. The purpose of this study was to review our results after the surgical treatment of these infants.
Methods:
We retrospectively reviewed all children below 3 years of age who underwent hip reconstruction for dislocated hips in the setting of cerebral palsy or other spastic/high-tone neuromuscular disease. Medical records were reviewed for clinical data including treatment course, complications, and need for further surgery. Preoperative and postoperative radiographs were used to determine International Hip Dysplasia Institute (IHDI) grade of dislocation, acetabular index, migration percentage, and presence of avascular necrosis according to the Salter criteria.
Results:
Eleven patients with 15 hips met our inclusion criteria with a mean age of 20±8 (range, 6 to 34) months. Preoperatively, 12 of 15 hips (80%) were IHDI grade 4 and 3 of 15 (20%) were IHDI grade 3. Mean acetabular index was 29±8 (range, 19 to 46) degrees. Patients underwent open reduction (15 hips), adductor tenotomy (14 hips), femoral osteotomy (10 hips), and pelvic osteotomy (12 hips). At a mean follow-up of 40±16 (range, 13 to 71) months, 13 of 15 hips were IHDI grade 1 (86.7%), 1 was IHDI grade 2 (6.7%), and 1 hip was IHDI grade 3 (6.7%). The mean postoperative migration index was 7%±24% (range, -30% to 46%); the mean acetabular index was 22±8 (range, 9 to 38) degrees. No patients developed radiographically significant osteonecrosis. Complications included 2 femur fractures (13.3%) and 1 symptomatic implant that required early removal. One patient underwent further reconstructive hip surgery.
Conclusions:
In this series of infants with hip dislocations and underlying spasticity, open reduction±pelvic osteotomy and/or femoral osteotomy has a nearly 90% success rate in achieving and maintaining adequate hip reduction at intermediate-term follow-up. In the unique population of infants with dislocated hips and underlying spasticity, comprehensive hip reconstruction is largely successful with an acceptable rate of complications.
Level Of Evidence:
Level IV-retrospective.
