One-stage treatment of hip dislocation with cerebral palsy via soft tissue release, hip reduction and osteotomy

Abstract

Objective To investigate the methods and outcomes of surgical treatment for hip dislocation with cerebral palsy (CP) via soft tissue release, hip reduction and osteotomy. Methods Nineteen CP patients (male: 9, female: 10; total 23 hips) with hip dislocation underwent reconstructive surgery between April 2010 and December 2016. The average age was 12.5±2.4 years. There were 17 diplegic, 1 hemiplegic and 1 quadriplegic patient. Gross motor function classification system distribution were type I in 2 patients, type II in 10 patients, type III in 5 patients, type IV in 2 patients. Combine one-stage surgical procedures included soft tissue release, close or open reduction of hip joint and femoral varus shortening or de-rotational osteotomy and pelvic osteotomy. During the follow-up period, the clinical symptom and radiological parameters including Sharp angle and acetabular index were recorded. Results The average follow-up duration was 2.1 years (1-4.5 years). The radiological parameters were evaluated at one year postoperatively. The migration percentage corrected to 6%±8% from 68%±21% with statistically significant different (t=12.760, P<0.001). The mean Sharp angle was 42°±8.9°, which was statistically significant reduced compared with the pre-operative value 59°±6.1° (t=9.058, P<0.001). In 15 patients with triradiate cartilage open, the acetabular index also improved from 34°±8.7° pre-operatively to 18°±10° with statistical significance (t=5.598, P<0.001). Total of 15 patients had gained hip stability and improved functional status. Hip pain, which happened in 11 patients preoperatively, all had relieved after operation. Four patients had dissatisfied results and re-subluxation happened in 3 hips. All of them had CE angle <20° immediately after operation (average, 17°±2.6°), which was significantly different compared with average CE angle 32°± 8.0° in non-recurrence hips (t=3.143, P=0.005). One patient, who underwent proximal hamstring release, had decline of function status and contralateral hip dislocation. Conclusion Dislocation hips in CP patients can be effectively treated with one stage soft tissue release, hip reduction and femoral and pelvic osteotomy. The selection of osteotomy method is based on the age and pathological changes of patients. Key words: Cerebral palsy; Hip dislocation; Osteotomy