Abstract
Internal hip rotation in cerebral palsy (CP) is typically treated with a femoral derotation osteotomy. This has been shown to be largely a successful procedure but recurrence rates up to 41% have been reported. Reported risk factors include younger age, reduced hip joint impulse and ankle plantar-flexion. We report on two patients with bilateral CP demonstrating recurrent unilateral internal hip rotation despite surgical intervention(s). Both demonstrate a number of the reported risk factors for recurrence. In addition, this case report specifically compared gait kinematic patterns pre and post recurrence. On comparing both patient’s hip rotation and ankle dorsi/plantarflexion kinematics they are seen to be almost identical both pre-operatively and post-operatively. Both patients appear to revert to approximately 30o of internal hip rotation which has been shown to maximise hip abductor function. Therefore, this case report suggests that surgical derotation in isolation is unlikely to be successful in this group and we suggest that this hip and ankle pattern may help predict recurrence in unilateral internal hip rotation.
Highlights
Cerebral Palsy (CP) is the most common cause of motor deficiency in young children occurring in 2.1 per 1000 live births (Oskoui et al, 2013)
Our clinical case report highlights recurrent internal hip rotation gait in two individuals with CP despite surgical intervention(s)
On comparing the joint kinematic graphs we have shown that in these two case reports, the position of recurrent internal hip rotation and ankle plantar-flexion are very repeatable both within each case following surgical intervention and between the two cases
Summary
Any reports and responses or comments on the article can be found at the end of the article. In this revised version of the manuscript he following changes were incorporated-. It has been made more obvious through-out the manuscript that this is a case report of two presenting patients rather than a formal study. This has led to more formal analysis of recurrence of internal hip rotation in our center, focusing on the kinematic pattern of hip rotation pre and post operatively as seen in the two cases presented here
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