Femoral varus-derotation osteotomy in spastic cerebral palsy

Twenty children (twenty hips) with spastic cerebral palsy underwent femoral varus-derotation osteotomy for which the principal indication was inadequate coverage of the femoral head. Other infrequent indications included pain, valgus angulation of the femoral neck, and dislocation of the hip. The age at surgery ranged from four to fifteen years. Each child had muscle releases before the osteotomy was done. At follow-up, at least seven years later, the femoral head in twenty hips was well centered. Four hips remained subluxated but were less subluxated than before the osteotomy. One hip remained dislocated. The center-edge angle averaged -8 degrees preoperatively and +17 degrees at follow-up. The neck-shaft angle averaged 155 degrees preoperatively, 114 degrees immediately post-operatively, and 125 degrees at follow-up. Femoral varus-derotation osteotomy, when combined with muscle releases, can allow children with spastic cerebral palsy to maintain their ambulatory status and may decrease pain about the hip.