The Journal of Bone and Joint Surgery, Vol 68, Issue 4 590-598, Copyright © 1986 by Journal of Bone and Joint Surgery, Inc
The treatment of the painful hip in cerebral palsy by total hip replacement or hip arthrodesis
L Root, JR Goss and J Mendes
The painful dislocated or subluxated hip in the patient with cerebral palsy
presents a difficult problem in management. Twenty-three patients with
cerebral palsy who had a painful subluxated or dislocated hip with
degenerative changes were operated on at The Hospital for Special Surgery.
Eight patients had a unilateral hip arthrodesis. Six had a successful
arthrodesis initially, resulting in relief of pain and return to the
preoperative functional level. A pseudarthrosis developed in two patients,
but both had successful revision surgery, one by a second arthrodesis and
the other by a total hip replacement. Thirteen of the fifteen patients with
a total hip replacement were pain-free and functioning at a level
consistent with their over-all involvement. One patient had migration of
the greater trochanter and slight bending of the femoral component, with
persistent pain. A second patient had progressive loosening of the femoral
component over a period of seven years, but continued to walk with minimum
pain. Two patients had a recurrent dislocation, one requiring revision of
the femoral component and the other, of the acetabular component. We think
that the presence of cerebral palsy, even in the patient with severe
involvement, is not a contraindication for either a hip arthrodesis or a
total hip replacement for a painful deformed or degenerated hip. These
patients should be treated for the pain in the hip, and the presence of the
underlying neuromuscular disorder should not deter the appropriate
treatment. For unilateral hip disease in patients who are unable to walk
and in young, active patients, we recommend hip fusion.(ABSTRACT TRUNCATED
AT 250 WORDS)
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