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International Orthopaedics
Published in: International Orthopaedics 8/2016

01-08-2016 | Original Paper

Hip-joint congruity after Dega osteotomy in patients with cerebral palsy: long-term results

Authors: Frank Braatz, Daniel Staude, Matthias C. Klotz, Sebastian I. Wolf, Thomas Dreher, Stefan Lakemeier

Published in: International Orthopaedics | Issue 8/2016

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Abstract

Introduction

Neurogenic hip dislocation is quite common in children with cerebral palsy (CP). The purpose of this study was to evaluate the long-term outcome of single-event multilevel surgery (SEMLS) in combination with hip reconstruction by using a periacetabular osteotomy as described by Dega concerning post-operative remodeling and plasticity of the femoral head post-operatively.

Methods

A total of 72 patients with CP as the primary disease and in whom a complex surgical hip reconstruction was performed during SEMLS between 1998 and 2004 were included in the study. There were 45 men and 27 women, with a median age of 7.6 (4.7–16.3) years at the time SEMLS was performed. The mean follow-up time was 7.7 years (4.9–11.8). X-rays were taken before and after surgery, and Rippstein 1 and 2 were used for follow-up. As the most reliable value for decentration, migration percentage (MP) as described by Reimers was used. To measure hip-joint cover at follow-up, the centre-edge angle was used. The hip was divided into four different categories according to sphericity and congruity. Using this approach, we could evaluate joint remodeling.

Results

Pre-operatively, the mean MP measured by X-ray was 68 %. Directly after surgery, this value decreased on average by 12 % and at the long-term follow-up was 16.0 % on average. A high rate of incongruence was observed on X-rays taken directly after surgery: 66 hip joints were classified as incongruent. The number of aspherical and incongruent joints decreased to 54 at the follow-up examination.

Conclusion

Data of our study with high plasticity of the hip joint suggest that even if the femoral head is deformed and a persistent incongruency after surgery is expected, hip reconstruction can be recommended.
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Metadata
Title
Hip-joint congruity after Dega osteotomy in patients with cerebral palsy: long-term results
Authors
Frank Braatz
Daniel Staude
Matthias C. Klotz
Sebastian I. Wolf
Thomas Dreher
Stefan Lakemeier
Publication date
01-08-2016
Publisher
Springer Berlin Heidelberg
Published in
International Orthopaedics / Issue 8/2016
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI
https://doi.org/10.1007/s00264-015-3013-2

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