The Journal of Bone and Joint Surgery, Vol 77, Issue 5 703-712, Copyright © 1995 by Journal of Bone and Joint Surgery, Inc
The severely unstable hip in cerebral palsy. Treatment with open reduction, pelvic osteotomy, and femoral osteotomy with shortening
L Root, FJ Laplaza, SN Brourman and DH Angel
Hospital for Special Surgery, New York, N.Y. 10021, USA.
The results in thirty-one patients with cerebral palsy who had a total of
thirty-five severely subluxated or dislocated hips were analyzed
retrospectively a mean of seven years after open reduction, pelvic
osteotomy, varus rotational osteotomy, and femoral shortening.
Preoperatively, twenty-two patients had been unable to stand and thirteen
had had pain; the mean acetabular index was 50 degrees, the mean
center-edge angle was -19 degrees, and the mean migration index was 74
percent. At the latest follow-up examination, none of the hips were
painful. Seven patients had an improvement of one level in their walking
ability. All of the patients who were confined to a wheelchair had better
sitting balance. The mean acetabular index was 40 degrees, the mean
center-edge angle was 18 degrees, and the mean migration index was 25
percent. Four hips were subluxated (two of them posteriorly). One hip was
treated with a repeat varus rotational osteotomy. Another hip, which was
not dislocated, had a rotational osteotomy for excessive femoral
anteversion. Eight femoral heads displayed signs of avascular necrosis. One
tibial and two femoral fractures occurred after the cast was removed. Three
of the four patients who had a subluxated hip had scoliosis. The combined
approach improved coverage of the femoral head and decreased pain in the
hip. Even though this procedure can be accompanied by serious
complications, we believe that the results justify this extensive approach
in these patients.
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