Hip Subluxation Research Articles

Hip Dysplasia in Congenital Zika Syndrome: A 5 Year Follow-Up

Children with Congenital Zika Syndrome (CZS) usually have severe neurological impairment with extrapyramidal involvement mainly spastic quadriplegia, so we believe they would have the same spasticity-related abnormalities, such as high prevalence of hip subluxation, as children with other aetiologies of cerebral palsy (CP).

Znaczenie systematycznej rehabilitacji na przestrzeni 45 lat pacjentki z rozwojową dysplazją stawu biodrowego (studium przypadku)

Congenital hip dysplasia is a teratogenic defect and affects 2% of the population; It arises in the fetal period and can be caused by pathological factors from both the mother and the fetus. The hallmark of congenital hip dysplasia is an undeveloped, excessively shallow acetabulum that prevents stabilization of the femoral head, resulting in hip dislocation. In recent years, there has been a shift in understanding of this musculoskeletal defect, based on early clinical and ultrasound findings, to developmental hip dysplasia, which can present as hip subluxation or dislocation. This paper presents the stages of treatment of a patient with developmental hip dysplasia over a 45-year period, the course of rehabilitation, and the effects of improvement after the use of CD34+ stem cells.

Solidarity with children and people with disabilities? : An economic analysis of reconstructive hip interventions in pediatric orthopedics

Brain damage in childhood can be caused cerebral palsy (CP) or be due to other diseases. Disturbance of muscle tone results in consecutive development of hip subluxation. Hip reconstructive surgery can significantly improve the mobility and quality of care of children. However, the DRG for surgical care of these conditions has been increasingly devalued. In Germany, this has already led to areduction of pediatric orthopedics departments, accompanied by an important risk of insufficient treatment options for children and people with disabilities. The aim of this retrospective study was an economic analysis of pediatric orthopedic interventions using the example of neurogenic hip decentration. For this purpose, the revenue-cost situation in patients with CP or other causes of brain damage was evaluated at amaximum care hospital in the period of 2019-2021. The entire analysis period showed adeficit. The non-CP-group showed the most important deficit. In CP-patients, however, the plus decreased each year and resulted in adeficit in 2021. While the distinction between cerebral palsy and other forms of brain damage in children is usually not relevant for treatment, it is evident that the non-CP group is massively underfinanced. Overall, the negative economic balance of pediatric orthopedics in the field of neurogenic hip reconstruction is clearly revealed. In the current interpretation of the DRG system, children with disabilities cannot be offered cost-effective care at amaximum-care university center.

Clinical and Functional Characteristics of a New Phenotype of SMA Type I among a National Sample of Spanish Children: A Cross-Sectional Study.

Spinal Muscular Atrophy (SMA) type I has classically presented extremely severe clinical features. New pharmacological treatments have led to a new phenotype of SMA. The aim of this study was to describe the current health and functional status of children with SMA. A cross-sectional study was conducted based on the STROBE guidelines. Patient questionnaires and standardized tools were used. A descriptive analysis was conducted establishing the proportions of subjects for each of the characteristics of interest. In total, 51 genetically confirmed SMA type I subjects were included. Fifty-seven percent received oral feeding, 33% received tube feeding and 10% combined both. Moreover, 21.6% had tracheostomies, and 9.8% needed more than 16 h/d ventilatory support. Regarding orthopedic status, 66.7% had scoliosis, and 68.6% had hip subluxation or dislocation. Up to 67% were able to sit independently, 23.5% walked with support and one child walked independently. Current SMA type I is a different entity from the classic phenotype but also from types II and III. In addition, no differences were found between SMA type I subgroups. These findings may enable the professionals involved in the care of these patients to improve their interventions in terms of prevention and rehabilitation measures for these children.

Can We Extend the Indications for Multilevel Surgery to Non-Ambulatory Children with Neuromuscular Diseases? A Safety and Efficacy Study

A retrospective study that aims to analyze the safety and efficacy of single-event multilevel surgery (SEMLS) involving bifocal femoral osteotomy (BFO) performed in nine non-ambulatory children with neuromuscular diseases (NMD), with a median age of 12.86 years, to resolve both hip subluxation and ipsilateral knee flexion contracture that impaired standing, and to evaluate patient and caregiver satisfaction. Results: Median surgical time was 4 h 15 min (2 h 35 min–5 h 50 min). Hip flexion deformity improved by a median of 30° (15–35), while median improvement in knee flexion deformity was 30° (20–50). Only two patients could use a standing frame prior to surgery, although with increasing difficulty, while all children could use it following SEMLS. Mean follow-up was 27.47 months (24.33–46.9). Significant blood loss requiring transfusion was the only complication recorded (8/9). All caregivers reported slight, moderate, or significant improvement in all domains of the questionnaire, and all would undergo the procedure again and recommend it to others, as nearly all (8/9) were very satisfied. Conclusion: The findings of this study suggest that SEMLS including BFOs in non-ambulatory children with NMD can correct hip, knee, and foot deformities and simultaneously realign lower limbs to restore functional standing and wheelchair transfer. The functional results, safety, and degree of satisfaction achieved justify offering this strategy to families.

Kindy Moves: the feasibility of an intensive interdisciplinary programme on goal and motor outcomes for preschool-aged children with neurodisabilities requiring daily equipment and physical assistance

ObjectivesTo determine the feasibility of an intensive interdisciplinary programme in improving goal and motor outcomes for preschool-aged children with non-progressive neurodisabilities. The primary hypothesis was that the intervention would be...

Evaluation and Management of Developmental Dysplasia of Hip (DDH) in Children - Our Experience

Introduction: DDH is the most common congenital anomaly of the musculoskeletal system in newborns. The disease ranges from a simple flattening of the acetabular cavity to the complete dislocation of the femoral head. Most developed countries report an incidence of 1.5 to 20 cases of DDH per 1000 births, depending in part on the methods of screening used. It includes a wide spectrum of hip alterations: neonatal instability; acetabular dysplasia; hip subluxation; and true dislocation of the hip. Aim of the Study: The aim of this study was to evaluate the management of the Developmental Dysplasia of Hip (DDH) in children. Methods: This retrospective study was conducted in the Department of Pediatric Surgery, Bangladesh Shishu Hospital & Institute, Dhaka, Bangladesh during the period from January2018 to December 2021. Result: In total 54 neonates completed the study. In our study we found majority (53.70%) of children were aged less than 4 months old. Followed by 25.93% & 20.37% were aged 1-2 months & 3-4 months respectively. Majority of neonates were girls (61.11%) compared to boys (38.89%). The highest risk factors of DDH was breech presentation (19%).We found that majority of neonates (70.37%) had dysplasia on left side and 7.41% had dysplasia on right side respectively. The prevalence of bilateral condition was 12(22.22%). Conclusion: DDH a common congenital anomaly that can be successfully treated non-operatively if detected early. For older individuals with dislocated or unstable hips, surgery is necessary. Surgery's function in treating acetabular dysplasia in children is changing and largely determined by symptoms. Expanding therapy choices for DDH and improved anatomical patient assessment skills among doctors will result in the proper intervention at the right time.

Developmental dysplasia of the hip is common in patients undergoing total hip arthroplasty under 50years of age.

Developmental dysplasia of the hip (DDH) refers to congenital and/or developmental hip instability that can result in hip joint subluxation or dislocation. When detected neonatally, conservative treatment with hip bracing can restore normal hip anatomy. Missed detection of DDH in the neonatal period or late development of DDH often requires surgical intervention to correct the abnormal anatomy. Furthermore, despite surgical intervention, residual sequelae may persist leading to early osteoarthritis of the hip joint requiring joint replacement surgery. This study investigates the prevalence of hip dysplasia in patients undergoing total hip arthroplasty (THA) under 50years of age. The hip arthroplasty database at a national referral centre was investigated from January 2014 to December 2020. In patients under 50years of age, those with an adequate pre-operative anteroposterior pelvic radiograph without previous hip arthroplasty were included, while those with inadequate radiographs were excluded. The following measurements were made on the contralateral non-operated hip: (1) lateral centre-edge angle (LCEA), (2) Tönnis angle, (3) acetabular version, (4) acetabular depth, (5) femoral head lateralisation, (6) femoral head extrusion index, and (7) acetabular depth-to-width ratio. In total, 451 patients were included in this study. Twenty two percent of the patients had hip dysplasia, based on a LCEA of<25° and 42.6% of patients had hip dysplasia, based on a Tönnis angle of>10°. The mean LCEA and Tönnis angle were 31.47±9.64 and 9.82±6.79°, respectively. Hip dysplasia is common in patients undergoing THA under the age of 50years with over 40% having dysplasia according to the Tönnis angle. Classification of primary and secondary osteoarthritis in the joint registries will benefit our knowledge on the prevalence of DDH in the adult population.

Lower Extremity Malformations.

Lower Extremity Malformations.

Physiatric treatment of hip dysplasia in a puppy: Case report

Hip dysplasia is a highly recurrent orthopedic condition that starts in the puppy with joint laxity and progresses to osteoarthrosis, which can cause severe pain and compromise the animal's quality of life. Its development is multifactorial and there are several described. In adults, there is a consensus that the treatment of the disease is multifactorial and encompasses environmental management, use of nutraceuticals, anti-inflammatories, and physical therapy. When there is no response the treatment, surgical procedures such as acetabular denervation, arthroplastic excision of the femoral head and total hip replacement can be performed. In puppies there are already studies that prove the hormonal, nutritional influence, and the development of muscle mass in the evolution of hip dysplasia. However, there is no previous report of a physiatric protocol for dysplastic puppies. Conservative treatment was performed on a male dog of the Saint Bernard breed with a severe degree of hip subluxation and valgus angular deviation from 4 to 9 months of age. With the application of functional electrostimulation, kinesiotherapy and photobiomodulation during 30 sessions, there was a significant improvement in muscular and cardiovascular resistance, an important reduction in claudication, muscle mass gain in the gluteal region and thigh extensors, reduction of angular deviation of the femorotibial joint and it was easier for it to stand up. It is concluded that physiatric techniques have the potential to control the factors that negatively influence the development of hip dysplasia and can be included in the conservative treatment in puppies, however further studies are needed.

Guided Growth Improves Coxa Valga and Hip Subluxation in Children With Hereditary Multiple Exostoses.

In children with severe hereditary multiple exostoses (HME), coxa valga, and hip subluxation are common deformities. The literatures related to surgical management and prevention of hip joint subluxation in HME are scarce. In this study, we aimed to investigate the efficacy of guided growth procedure to correct coxa valga and hip subluxation in HME patients. We retrospectively retrieved 12 patients who received guided growth procedures for coxa valga and hip subluxation in HME patients with proximal femur exostoses with a minimum follow-up time of 2 years between 2012 and 2019. Radiographic parameters include head-shaft angle, Hilgenreiner-epiphyseal angle, acetabular index, Reimer migration percentage, center-edged angle, articulo-trochanteric distance, and femoral neck length for comparison between preoperative and latest follow-up results. It was conducted statistically by paired t test and Wilcoxon signed rank test. In this study, the mean difference between preoperative and latest follow-up was significant in head-shaft angle (12±5 degrees; CI, 10-14; P<0.001), Hilgenreiner-epiphyseal angle (12±5 degrees; CI, 10-15; P<0.001), and MP (7%±8%; CI, 3-11; P=0.001). There was a low revision rate (4 of 21, 19%) and no complication in our study. Compared with previous studies on guided growth in children with cerebral palsy and developmental dysplasia of the hip, our study showed good comparable outcomes. The results indicated that guided growth improves the hip radiographic parameters of children with HME and may prevent coxa valga and hip subluxations. It is a safe procedure and provides predictable results. Level IV; therapeutic, case series.

Subtle hip joint subluxation after femoral neck fracture fixation: an ominous sign in a report of two cases

Bhatia, Nishant MS Ortho; Khan, Yasim MS Ortho, DNB Ortho; Garhia, Saurabh MBBS; Maini, Lalit MS Ortho Author Information

Motorized Plate Lengthening of the Femur in Children: A Preliminary Report.

Limb lengthening by distraction osteogenesis can be performed with motorized internal devices, but intramedullary implants risk avascular necrosis of the femoral head in young children. A method of internal limb lengthening using a motorized expandable plate has been developed and preliminary results are presented. Seven skeletally immature patients (ages 2.7 to 9.7y) with congenital femoral deficiencies underwent femoral lengthening with the use of a magnetic expandable plate. Surgical details, lengthening parameters, Limb Lengthening and Reconstruction Society-Angular deformity, Infection, Motion index, and complications were reviewed and classified according to the modified Clavien-Dindo system. An average lengthening was 4.1cm (range, 3.3 to 4.4cm) comprising 18% of initial femoral segment length (range, 14% to 21%). The average lengthening phase was 50.2 days (range, 40 to 57d) and weight-bearing was initiated at an average of 13 weeks from surgery (range, 8 to 18wk). Limb deformities and length discrepancies were of moderate complexity, with an Limb Lengthening and Reconstruction Society-Angular deformity, Infection, Motion score of 6.57 (range, 6 to 7). Complication rates were comparable to previously reported methods of femoral lengthening. One patient underwent reoperation for patellar instability and 1 patient experienced radiographic hip subluxation which was observed. Small magnitude varus was observed in regenerate in 3 of 7 cases, none requiring treatment. Preoperative planning consisted of careful localization of the corticotomy site, acute deformity correction at the lengthening site in 3 cases, and implant orientation. Limb lengthening with motorized internal plates is feasible for young children with congenital femoral deficiency for whom intramedullary lengthening is unsafe or if external fixation is to be avoided. However, the fundamental principles of distraction osteogenesis and risks of lengthening for congenital discrepancies remain unchanged. Specific considerations herein include: careful planning of implant length and positioning, adjacent joint protection with adjunctive means, and mitigating deformity of the regenerate during distraction. Level IV, retrospective case series.

Hip subluxation in Italian cerebral palsy children and its determinants: a retrospective cohort study.

The study's aim was two-fold: to describe the trend of hip subluxation in the largest sample of Italian nonambulatory cerebral palsy (CP) children ever published; to investigate its determinants. This single-centre retrospective cohort study included patients with spastic or dyskinetic CP, Gross Motor Function Classification System (GMFCS) level IV or V, age 0-18 years, having been referred to our unit before March 2020. The hip subluxation was measured by means of the migration percentage (MP). Other data were gathered such as sex, CP subtype, GMFCS level, presence of drug-resistant epilepsy, age, use of walkers with weight relief or standing devices, previous botulinum injection or hip surgery, oral or intrathecal baclofen and hip pain. Multiple linear stepwise regression was performed and descriptive statistics are provided. Spastic CP had MP maximum increase in early ages, with GMFCS level V values persistently higher than level IV. The dyskinetic subtype showed a slower increase of the MP, with GMFCS level IV presenting similar or higher values, compared to level V. Age, CP severity and spastic subtype are the main determinants. The stepwise multiple regression analysis demonstrated that weight relief walking and standing assistive devices, combined with botulinum contributed to reduce the MP progression. Dyskinetic CP showed overall lower MP values and a more variable behaviour relative to age and GMFCS level, compared to the spastic subtype. Standing and walking assistive devices, with partial or total weight relief, combined with individually targeted botulinum injections, should be considered in the management of bilateral nonambulatory CP patients, to prevent hip subluxation or its recurrence after surgery.

Periacetabular osteotomy with or without femoral osteotomy for the treatment of hip subluxation in children and young adults with cerebral palsy

BackgroundThis study is aimed to investigate retrospectively the radiographic and clinical outcomes in children and young adults with cerebral palsy (CP) undergoing periacetabular osteotomy (PAO) with or without femoral osteotomy (FO) for hip subluxation.MethodsA consecutive cohort of twenty-one patients (23 hips) with symptomatic CP hip subluxation were treated with PAO with or without FO and reviewed retrospectively. Two patients (2 hips) were excluded due to insufficient follow-up and lost to follow-up, respectively. The Reimers migration percentage, lateral center-edge angle (LCEA), Sharp angle, neck-shaft angle (NSA), femoral anteversion (FNA), Gross Motor Function Classification System (GMFCS) and hip pain were assessed.ResultsTwenty-one hips (19 patients) with CP treated with PAO with or without FO were included. Five hips received PAO. Sixteen hips underwent PAO with FO. Mean age at surgery was 19 ± 6 and 15 ± 4 years for PAO and PAO plus FO, respectively. Mean follow-up was 44.0 ± 28.3 months for PAO and 41.5 ± 17.2 months for PAO + FO. All hips were painful before surgery and painless at final visits. The GMFCS improved by one level in 10 of 19 patients. There was significant increase in LCEA (p < 0.001) and decrease in the Reimer’s MP (p < 0.001), NSA (p < 0.001) and Tonnis angle(p < 0.001) postoperatively. Resubluxation occurred in 7 hips (30%) due to insufficient correction and loosening of fixation. Nervus cutaneus femoris lateralis was impaired in 4 patients after surgery. There was no avascular necrosis of the femoral head, resubluxation or infection.ConclusionPAO with or without FO can be effective for children and young adults with concomitant hip subluxation and CP.

Treatment of Stage I-III Hip Joint Tuberculosis With Open Surgical Debridement and Hip Spica in Children: A Retrospective Study.

Background:This study aimed to evaluate the outcome of surgical debridement combined with postoperative hip spica immobilization in the treatment of hip joint tuberculosis in children.Methods:This retrospective study enrolled 87 children with stage I to III hip joint tuberculosis treated surgically at our hospital from January 2010 to January 2016. All patients considering hip tuberculosis routinely received a 4-week conservative treatment first, including rest, protected weight-bearing, and 4-drugs antitubercular chemotherapy. Surgical debridement was indicated when there was no relief after this conservative protocol. Patients were divided into 2 groups according to the duration of hip spica immobilization after operation: group A (hip spica for 4 wk, 39 patients) and group B (hip spica for 6 wk, 48 patients). All patients were recommended partial weight-bearing for 7 days and then followed the same hip joint exercises program when spica was removed. Postoperative radiographs, hip dislocation or subluxation, and modified Harris hip score (MHHS) were assessed. All patients were followed up at least 5 years.Results:There were 87 patients enrolled in our study, including 34 females and 53 males, with a mean age of 7.2±2.8 years old (range: 2 to 14 y). No significant difference was observed between these 2 groups in baseline data. In group A, the mean MHHS improved from 52.1±14.7 before surgery to 87.8±8.3 at the final follow-up (P<0.000). In group B, there was also a significant difference between the preoperative MHHS (52.7±9.4) and the final MHHS (88.6±6.5) (P<0.000). Although there was no significant difference between these 2 groups in the final MHHS (P=0.593), there were also no significant differences between these 2 groups in wound healing delay (3 in group A and 6 in group B, P=0.705) and pathologic subluxation (3 in group A and 1 in group B, P=0.467). The only difference between group A (79.2±8.5) and group B (75.5±7.5) was the early functional outcome assessed by using MHHS after 1 month of hip joint exercises (P=0.032).Conclusions:Surgical debridement combined with antitubercular chemotherapy is an effective treatment for stage I to III hip tuberculosis in children when there is no improvement after conservative treatment. Prolonged hip spica immobilization may not reduce the risk of hip subluxation after open surgical debridement but could lead to a delay in early functional recovery. Time of spica immobilization should be individualized and based on the surgeon’s evaluation and the patient’s condition.

Risk factors for hip displacement in cerebral palsy: A population-based study of 121 nonambulatory children.

Purpose:The aim was to evaluate which clinical and radiographic variables are independent (true) risk factors for hip subluxation in nonambulatory children below 5 years of age with cerebral palsy.Methods:Patients were recruited from a population-based hip surveillance program. Inclusion criteria were birth during 2002–2006, age below 5 years, and gross motor function classification system levels III–V. In all, 121 children (71 boys) met these criteria. Gross motor function classification system was level III in 29 patients, level IV in 28, and level V in 64. Anteroposterior radiographs at diagnosis and during follow-up were assessed, and only the worst hip of each patient was used for the analyses. The mean age at the initial radiograph was 2.5 years (range: 0.7–4.9 years), and the mean follow-up time was 4.0 years (range: 0.5–11.8 years).Results:At the last follow-up, 67 children had a clinically significant hip displacement, defined as migration percentage ≥40%. Univariable regression analysis defined these risk factors: gross motor function classification system level V, spastic bilateral cerebral palsy, initial migration percentage, yearly rate of migration percentage progression, and initial acetabular index. When these variables were analyzed with multivariable regression in 107 patients with initial migration percentage <50% and follow-up ≥1.0 year, the independent risk factors were initial migration percentage (p = 0.003) and yearly rate of migration percentage progression (p < 0.001).Conclusion:The parameters that need to be assessed in hip surveillance in children below 5 years of age are initial migration percentage and rate of migration percentage progression. Acetabular index and femoral head–shaft angle might be useful later for decision-making regarding choice of treatment.Level of evidence:Level II, development of diagnostic criteria.

Reduced dynamic loads due to hip dislocation induce acetabular cartilage degeneration by IL-6 and MMP3 via the STAT3/periostin/NF-κB axis

Developmental dysplasia of the hip (DDH) is characterized by anatomical abnormalities of the hip joint, ranging from mild acetabular dysplasia to hip subluxation and eventually dislocation. The mechanism underlying the cartilage degeneration of the hip joints exposed to reduced dynamic loads due to hip dislocation remains unknown. We established a rodent hip dislocation (disarticulation; DA) model of DDH (DA-DDH rats and mice) by swaddling. Expression levels of periostin (Postn) and catabolic factors, such as interleukin-6 (IL-6) and matrix metalloproteinase 3 (Mmp3), increased and those of chondrogenic markers decreased in the acetabular cartilage of the DA-DDH models. Postn induced IL-6 and Mmp3 expression in chondrocytes through integrin αVβ3, focal adhesion kinase, Src, and nuclear factor-κB (NF-κB) signaling. The microgravity environment created by a random positioning machine induced Postn expression in chondrocytes through signal transducer and activator of transcription 3 (STAT3) signaling. IL-6 stimulated Postn expression via STAT3 signaling. Furthermore, cartilage degeneration was suppressed in the acetabulum of Postn−/− DA-DDH mice compared with that in the acetabulum of wild type DA-DDH mice. In summary, reduced dynamic loads due to hip dislocation induced acetabular cartilage degeneration via IL-6 and MMP3 through STAT3/periostin/NF-κB signaling in the rodent DA-DDH models.

Kabuki syndrome with ossification of the posterior longitudinal ligament requiring differentiation from Ehlers-Danlos syndrome: a case report with a literature review

Kabuki syndrome (KS) comprises multiple congenital abnormalities and the main symptoms include characteristic facial features, skeletal and spinal abnormalities, and mental retardation. The estimated incidence of KS is 1 in 32000, and mutations in the KMT2D gene (also known as MLL2) are considered to be involved. The details of such mutations, including the mode of inheritance, are unclear. A 40-year-old woman visited our hospital with back pain and urinary incontinence. The patient had been diagnosed with Ehlers-Danlos syndrome (EDS) in childhood, on the basis of physical findings including hip subluxation. Because of her characteristic facial features, we suspected KS instead. Genetic testing revealed the presence of a rare missense mutation in KDM6A that was suggestive of KS. Computed tomography showed that she had ossification of the posterior longitudinal ligament (OPLL). On the basis of her clinical presentation and genetic mutation in KDM6A, we made a diagnosis of KS with OPLL. Hereditary diseases may share similar clinical characteristics, as in the case of our patient with Kabuki syndrome, who was misdiagnosed in childhood as having an Ehlers-Danlos syndrome involving disordered connective tissue. Physicians should undertake a comprehensive consideration of multiple clinical features when diagnosing a hereditary disease.

Long-term outcomes of hip reconstruction surgery in children with GMFCS III diplegic cerebral palsy

IntroductionThe results of hip reconstruction surgery are known for non-walking (GMFCS IV and V) and walking (GMFCS I and II) patients. Few studies deal with GMFCS III patients in isolation. Their intermediate functional status can be deteriorated by asymmetrical contractures, hip dislocation, multi-level deformities of the lower limbs, leading to motor function degradation, and possibly losing their ability to walk. The aim of our study was to establish whether surgical results were maintained over time and whether the functional status changed. Material and methodsFifteen patients with GMFCS III spastic diplegia, treated for hip subluxation, were reviewed. The mean age at the time of surgery was 10 years old. The mean follow-up after surgery was 11 years. Reconstructive surgery was performed on 21 hips including pelvic osteotomy in all cases, with associated femoral osteotomy in 19 cases. Clinical (pain, joint mobility, walking aids, walking distance, GMFCS level) and radiological data (Melbourne Cerebral Palsy Hip Classification, standard coxometry) were recorded preoperatively and at the last follow-up. ResultsPreoperatively, 6 patients were losing their ability to walk due to pain and flexion-adduction contracture. At the last follow-up, no patients had pain and joint mobility was improved in all cases. For one patient, recovery to their previous functional state required a period of two years. In the long term, 14 patients were GMFCS III and only one patient was GMFCS IV due to reasons unrelated to hip surgery. The radiological parameters improved significantly. The Melbourne score was IV preoperatively for all patients. At the last follow-up, 10 hips were grade I, 6 hips were grade II and 5 hips were grade III. DiscussionCorrection of architectural disorders of the subluxed hip by pelvic osteotomy, in most cases associated with femoral osteotomy, improves functional and radiological status for GMFCS III patients. This improvement is maintained in the long-term. Complementary surgeries correcting the other deformities of the lower limbs were necessary in more than half of the patients. Level of evidenceIV.