Salvage Treatment Options for Painful Hip Dislocations in Nonambulatory Cerebral Palsy Patients
K Aaron Shaw1, Justin M Hire, David M Cearley
1From the Department of Orthopaedic Surgery (Dr. Shaw), Dwight D. Eisenhower Army Medical Center, Fort Gordon, GA, the Department of Orthopaedic Surgery (Dr. Shaw and Dr. Cearley), Children's Hospital of Georgia at Augusta University, Augusta, GA, and the Department of Orthopaedic Surgery (Dr. Hire), General Leonard Wood Army Community Hospital, Fort Leonard Wood, MO.
Abstract:
Hip dislocation is a common occurrence in nonambulatory patients with cerebral palsy, occurring in up to 70% of patients. However, only 15% to 57% of chronic dislocations progress to become painful. In these patients, several salvage treatment options are available, including proximal femoral resection, subtrochanteric valgus osteotomy, hip arthrodesis, and prosthetic arthroplasty. Of the options, proximal femoral resection, subtrochanteric osteotomy, and prosthetic arthroplasty have been shown to provide reliable pain relief with improved sitting balance, with no evidence of one technique being superior to another. However, each technique has unique aspects to its postoperative care and potential complication profile that requires thorough understanding and communication with parents/caregivers when considering surgical intervention.
