Abstract
PurposeProximal femoral excision is a salvage procedure for painful chronic hip dislocation in cerebral palsy (CP) patients. The primary objective of this article is to describe our experience of an amplified interposition myoplasty, with appropriate peri-operative pain and tone management strategies, in a cohort of non-ambulatory CP patients with painful chronic hip dislocation. Our secondary objective is to present the clinical outcomes of these patients.MethodsWe describe our experience in 20 CP patients (25 procedures) at mean 54-month (range 27–169) follow-up with a surgical technique that includes an augmented interposition myoplasty and tone management. The indications for surgery were pain (21 hips), poor sitting tolerance (11) and difficulty with perineal care (8).ResultsThe mean age was 22 years (range 10–40) with 11 patients Gross Motor Function Classification Scale (GMFCS) IV and 9 patients GMFCS V. Mean length of stay was 13 days (3–35). One procedure required revision at 12 months. Mean pain score improved from 7.8 (5–10) pre-operatively to 2.8 (1–5) post-operatively (p < 0.001). Sitting tolerance improved in all patients and in 75 % (15) perineal care was easier.ConclusionsOur interposition myoplasty technique with individualised pain/tone management has good outcomes in this cohort of patients with multiple co-morbidities.Electronic supplementary materialThe online version of this article (doi:10.1007/s11832-015-0662-z) contains supplementary material, which is available to authorized users.
Highlights
Despite preventative screening programmes in some countries [1], in many others [2,3,4,5], chronic hip dislocation occurs in up to 75 % of the most severely affected nonambulant cases of cerebral palsy (GMFCS IV/V) [6,7,8]
The primary objective of this article is to describe our experience of an amplified interposition myoplasty, with appropriate peri-operative pain and tone management strategies, in a cohort of non-ambulatory cerebral palsy (CP) patients with painful chronic hip dislocation
We describe our experience in 20 CP patients (25 procedures) at mean 54-month followup with a surgical technique that includes an augmented interposition myoplasty and tone management
Summary
Despite preventative screening programmes in some countries [1], in many others [2,3,4,5], chronic hip dislocation occurs in up to 75 % of the most severely affected nonambulant cases of cerebral palsy (GMFCS IV/V) [6,7,8]. This is related to muscle imbalance and spasticity, as well as immobility and excessive femoral anteversion [9]. All these issues can contribute to sleep disturbance and adversely affect the quality of life of both the patient and their caregivers
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