Abstract
Background and purpose — Hip dislocation in cerebral palsy (CP) is caused by altered muscle forces on the joint during typical hip positioning in adduction–flexion–inward rotation. Preventive surgery includes adductor–psoas lengthening (APL) or varus derotation osteotomy (VDRO) of the proximal femur. We assessed the changes in the hip abduction range after these operations. Patients and methods — Data were obtained from the Swedish Surveillance Programme for CP. The range of hip abduction before and up to 18–36 months after surgery was assessed for all children who underwent APL or VDRO. Data for 1 hip per child was assessed. Ordinary linear regression was used. Results — In the 150 children who underwent APL, the mean range of abduction increased from 29° (95% confidence interval [CI] 28–32) preoperatively to 37° (CI 35–39) at 18–36 months. In the 157 children who underwent VDRO, the respective mean values were 30° (CI 29–32) and 29° (CI 28–31). The mean difference in preoperative abduction between sides was greater in children who underwent unilateral (9.4°, CI 7.8–11) than bilateral (5.5°, CI 3.4–7.6) VDRO. At 18–36 months postoperatively, the differences between sides were almost unchanged. Interpretation — The range of hip abduction increased after APL but remained unchanged after VDRO. This may explain the normal development of hip displacement after these operations. Differences in abduction between sides were not substantially affected by whether VDRO was performed uni- or bilaterally.
Highlights
Patients and methods — Data were obtained from the Swedish Surveillance Programme for cerebral palsy (CP)
In CPUP, children are examined by their local physiotherapist at intervals based on age and gross motor function according to the Gross Motor Function Classification Scale (GMFCS), a 5-point scale in which level V indicates the greatest disability [14]
Preventive surgery is recommended when the migration percentage (MP) [5] exceeds 40%
Summary
Patients and methods — Data were obtained from the Swedish Surveillance Programme for CP. Interpretation — The range of hip abduction increased after APL but remained unchanged after VDRO This may explain the normal development of hip displacement after these operations. Proximal femoral varus derotation osteotomy (VDRO), sometimes combined with pelvic osteotomy, is a reconstructive surgery that aims to correct the displacement momentarily This varization can reduce the range of abduction and, to compensate for this, VDRO is often combined with APL and shortening of the femur. Opinions differ as to whether VDRO should be performed bilaterally, even in patients with unilateral hip displacement [7,8,9] After both APL and VDRO, there is a risk of recurrent hip displacement and the need for repeated surgery [10,11,12]
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