Treatment of hip problems in cerebral palsy

The two major problems of the hip in cerebral palsy relate to gait abnormalities and hip instability. Gait abnormalities are a result of muscle imbalance and should be corrected with appropriate muscle transfers and releases. Frequently, femoral anteversion may be associated with internal rotation of the limb, and if severe, should be corrected. Hip instability leading to S/D is a very serious problem in cerebral palsy and is usually worse in the more severely involved patients. Early muscle releases should be done before the hips subluxate. Once subluxation occurs, muscle releases must be combined with a varus rotation osteotomy. If acetabular insufficiency is present, pelvic osteotomy is necessary to obtain stability. In the older patient who has a painful S/D hip, the author recommends either a hip arthrodesis or a total hip replacement.