105.
Pelvic Osteotomy for Hip Subluxation and Dislocation in Children
with Cerebral Palsy
Michael Schultz-Larsen, Nikolaj A Sode, Vilhelm Engell, Niels Wisbech
Pedersen
Health Care Unit Danish National Defence; Department of Orthopedics,
Division, Odense University Hospital, Denmark; Department of Orthopedics,
Division, Odense University Hospital, Denmark; Department of Orthopedics,
Division, Odense University Hospital, Denmark
Background:
Children with cerebral palsy (CP) are known to have a high risk
of hip displacement. The development of hip deformity in spastic patients is
thought to be secondary to asymmetric muscle forces produced across the hip
adductors, iliopsoas, and hamstrings. Uncorrected hip subluxation or
dislocation may lead to later problems with pain, perineal care, and sitting
balance.
Purpose / Aim of Study:
The purpose of this paper is to review the results of
pelvic osteotomy with or without varus derotational femoral osteotomy and
soft tissue release, in a group of cerebral palsy patients with uni- or bilateral
hip subluxation or dislocation
Materials and Methods:
A retrospective chart and radiograph review was
carried out for all cases of severely involved CP patients followed at Odense
University Hospital during the period 2009 to 2011 and undergoing pelvic
osteotomy with or without intertrochanteric varus, rotation and shortening
osteotomy and soft tissue release. Surgical procedures carried out were
gathered through chart and radiograph review. Clinical information and
follow-up data were obtained from medical records. We determined the effect
of the pelvic osteotomy by measuring the acetabular index (AI), centre edge
angle (CEA) pre- and postoperatively and when appropriate the line of
shenton.
Findings / Results:
35
children with CP met the inclusion criteria. The
male:female ratio was 24:11. None of the patients suffered postoperative
infection. The AI improved in 27 hips while 5 hips had the same angle and 1
hip had a 2-degree increase postop. In all patients, despite one, the CEA
improved from 2 to 44 degrees.
Conclusions:
The results of this study demonstrate that good clinical and
radiological result can be achieved with varus derotation osteotomy combined
with soft tissue release as treatment for subluxated or luxated hips in cerebral
palsy children.
