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Hip dislocation in spastic cerebral palsy: long-term consequences.

D R Cooperman, E Bartucci, E Dietrick

    Journal of Pediatric Orthopedics
    |May 1, 1987
    PubMed
    Summary
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    Surgical reduction of dislocated hips in spastic quadriplegic cerebral palsy patients may improve outcomes. Early intervention for unilateral dislocations is recommended, potentially benefiting bilateral cases before femoral head deformity.

    Area of Science:

    • Orthopedics
    • Neurology
    • Rehabilitation Medicine

    Background:

    • Spastic quadriplegic cerebral palsy (CP) frequently involves hip dislocations.
    • Hip dislocations in CP can lead to pain, pelvic obliquity, and scoliosis.
    • Long-term outcomes of hip dislocations in this population are not well-established.

    Purpose of the Study:

    • To evaluate the long-term outcomes of hip dislocations in noninstitutionalized patients with spastic quadriplegic cerebral palsy.
    • To determine the impact of hip reduction surgery on functional status and associated deformities.

    Main Methods:

    • Retrospective evaluation of 51 dislocated hips in 38 patients with spastic quadriplegic CP.
    • Mean follow-up of 18 years (average age 26 years).
    • Analysis of ambulatory status, pelvic alignment, scoliosis, and pain in relation to hip reduction.

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    Main Results:

    • Four patients (10.5%) were ambulatory with aids at follow-up.
    • Patients who could walk had normal intelligence and a level pelvis.
    • Unreduced unilateral hip dislocations were associated with higher rates of pelvic obliquity and scoliosis (12/18) compared to reduced dislocations (2/7).
    • Half of all dislocated hips were painful.

    Conclusions:

    • Reduction of unilateral hip dislocations in spastic quadriplegic CP is recommended.
    • Bilateral hip dislocation reduction may be beneficial if performed before significant adaptive deformity of the femoral head.
    • Early surgical intervention may mitigate secondary complications like pelvic obliquity and scoliosis.