Percutaneous Subtrochanteric Osteotomy for Painful Dislocated Hips in Patients With Cerebral Palsy.

Abstract

Treatment of a painful, chronically dislocated hip in nonambulatory children with cerebral palsy (CP) is challenging and controversial. Although many surgical options have been described, there is limited information, including patient-centered outcomes, following treatment. The purpose of our study was to evaluate the effect of a percutaneous subtrochanteric valgus osteotomy (SVO) using external fixation (EF) on hip abduction, radiographic parameters, and quality of life (QOL) measures in such patients. Fifteen nonambulatory patients (8 male, 7 female) with CP with 19 chronically dislocated hips underwent SVO using EF and adductor tenotomy at an average age of 14.3 years (range, 10.7 to 26.8 y). Changes in hip abduction and radiographic angular correction following surgery were assessed. Caregivers completed 2 surveys detailing differences in the patient's QOL measures, including severity and duration of pain and ease of nursing care, and the modified Child Health Index of Life with Disabilities (CPCHILD). Caregivers of 11 patients completed both surveys at an average follow-up of 50 months (range, 17 to 119 mo) after fixator removal. There was improvement in pain, sitting tolerance, ease of transfers, and perineal care in the majority (9/11) of patients. The modified CPCHILD (possible score, 10 to 50) improved from 27.2 to 16.23 (P=0.05). Hip abduction improved from -7 degrees (range, -32 to 5 degrees) to 24 degrees (range, 0 to 40 degrees) (P<0.0001). The average valgus osteotomy correction was 48.2 degrees (range, 2.2 to 93.2 degrees). The pelvic femoral shaft angle improved from -15.2 degrees (range, -47.7 to 7.4 degrees) to 15.4 degrees (-44.3 to 44.6 degrees). There was some correlation of both, change in hip abduction (R=0.55) and osteotomy angle (R=0.60), with improvement in QOL measures. There were 3 major complications (20%) in 15 patients. On the basis of preliminary results, percutaneous SVO stabilized with EF improves QOL in the majority of nonambulatory CP patients despite untoward events and is a viable alternative to open osteotomy with internal fixation. More robust comparative studies are needed to further assess the optimal salvage technique in this patient population. Level IV.