One stage soft tissue release, open reduction, femoral shortening, osteotomy and peri acetabular augmentation for spastic dislocated hip-early results

Abstract

Objectives: The goals of hip surgery in cerebral palsy are to maintain adequate reduction of the femoral head, prevent pain, improve sitting balance and maintain motion and the ambulatory status of the patient. It is now well accepted that soft tissue release, open reduction and femoral shortening were necessary for a stable hip along with some type of pelvic osteotomy. We evaluated the clinical and radiological results of one-stage correction of hip dislocation for cerebral palsy patients. Materials and Methods: We reviewed clinical outcomes and radiologic indices of 32 dislocated hips in 24 children with cerebral palsy (13 males, 11 females; mean age, 8.6 years). All 32 hips had dislocation. Preoperative Gross Motor Function Classification System (GMFCS) scores of the patients were as follows; level V (13 patients), level IV (9), and level III (2). The combined surgery included release of contracted muscles, (adductors, rectus femoris, iliopsoas) open reduction of the femoral head, femoral shortening varusderotation osteotomy and the modified Dega osteotomy along with shelf procedure. Hip range of motion, GMFCS level, acetabular index, center- edge angle, migration percentage, neck shaft angle, Sharp's angle was measured before and after surgery. The mean follow-up period was 38.1 months. Results: Hip abduction (median, 40°), sitting comfort and GMFCS level were improved after surgery, and pain was decreased. There were no femoral head avascular necrosis, no infection or nonunion. There was no redislocation. All radiologic indices showed improvement after surgery. Conclusions: So, we believe that a combined approach of muscle releases, open reduction, femoral shortening varus-derotation osteotomy, Dega osteotomy and penicapsularacetabular augmentation was a highly effective method for the treatment of spastic dislocated hips in our patients.