Top

Journal of Children's Orthopaedics

Published in:

Open Access 01-05-2014 | Original Clinical Article

One-stage hip reconstruction in children with cerebral palsy: long-term results at skeletal maturity

Authors: Cindy Mallet, B. Ilharreborde, A. Presedo, A. Khairouni, K. Mazda, G. F. Penneçot

Published in: Journal of Children's Orthopaedics | Issue 3/2014

Abstract

Purpose

Hip subluxation is common in children with cerebral palsy (CP). Surgery is indicated in case of pain or progressive increase of Reimers index on radiographs. Peri-iliac osteotomy combined with femoral osteotomy is one of the numerous operative techniques available, but results at skeletal maturity remain unclear. The purpose of this radiological study was to report the long-term results of this procedure.

Materials and methods

Twenty hips in 20 children were retrospectively evaluated at skeletal maturity. Mean age at surgery was 8.1 years and follow-up averaged 9.1 years. All patients underwent Dega acetabuloplasty, soft-tissue release and femoral-shortening varus derotation osteotomy without open reduction. Reimers index, acetabular angle (AA) and neck-shaft angle (NSA) were compared on preoperative, postoperative and latest follow-up radiographs.

Results

Dega osteotomy significantly improved the AA and the correction remained stable at maturity. The NSA significantly decreased postoperatively (153°–115°), but recurrence of the valgus deformity (130°) of the proximal femur was observed at maturity. Consequently, Reimers index followed the same evolution. No case of osteonecrosis was reported but one hip dislocated and one subluxated during follow-up.

Conclusion

Progressive recurrence of the valgus deformity of the proximal femur, attributable to adductors spasticity and gluteus medius weakness, led to a significant increase in the Reimers index. However, hip coverage remained >70 % at maturity in 90 % of the hips. This one-stage procedure without hip dislocation efficaciously corrected acetabulum dysplasia and successfully treated neurological hips in CP patients.

Level of evidence

IV: retrospective study.

Soo B, Howard JJ, Boyd RN et al (2006) Hip displacement in cerebral palsy. J Bone Jt Surg Am 88(1):121–129CrossRef

Noonan KJ, Walker TL, Kayes KJ et al (2001) Varus derotation osteotomy for the treatment of hip subluxation and dislocation in cerebral palsy: statistical analysis in 73 hips. J Pediatr Orthop Part B 10(4):279–286

Mubarak SJ, Valencia FG, Wenger DR (1992) One-stage correction of the spastic dislocated hip. Use of pericapsular acetabuloplasty to improve coverage. J Bone Jt Surg 74(9):1347–1357

Sankar WN, Spiegel DA, Gregg JR et al (2006) Long-term follow-up after one-stage reconstruction of dislocated hips in patient with cerebral palsy. J Pediatr Orthop 26:1–7PubMedCrossRef

Jozwiack M, Marciniak W, Piontek T et al (2000) Dega’s transiliac osteotomy in the treatment of spastic hip subluxation and dislocation in cerebral palsy. J Pediatr Orthop B 9(4):257–264CrossRef

Dhawale AA, Karatas AF, Holmes L et al (2013) Long-term outcome of reconstruction of the hip in young children with cerebral palsy. Bone Jt J 95-B:259–265CrossRef

Miller F, Girardi H, Lipton G et al (1997) Reconstruction of the dysplastic spastic hip with peri-iliac pelvic and femoral osteotomy followed by immediate mobilization. J Pediatr Orthop 17(5):592–602PubMedCrossRef

Reimers J (1980) The stability of the hip in children. A radiological study of the results of muscle surgery in cerebral palsy. Acta Orthop Scand Suppl 184:1–100PubMedCrossRef

Laurenson RD (1959) The acetabular index. A critical review. J Bone Jt Surg 41-B(4):702–710

10.

Tönnis D, Brunken D (1968) Differentiation of normal and pathological acetabular roof angle in the diagnosis of hip dysplasia. Evaluation of 2294 acetabular roof angles of hip joints in children. Arch Orthop Unfallchir 64(3):197–228PubMedCrossRef

11.

Kay RM, Jaki KA, Skaggs DL (2000) The effect of femoral rotation on the projected femoral neck-shaft angle. J Pediatr Orthop 20:736–739PubMedCrossRef

12.

Robin J, Graham HK, Baker R et al (2009) A classification system for hip disease in cerebral palsy. Dev Med Child Neurol 51(3):183–192PubMedCrossRef

13.

McNerney NP, Mubarak SJ, Wenger DR (2000) One-stage correction of the dysplastic hip in cerebral palsy with the San Diego acetabuloplasty: results and complications in 104 hips. J Pediatr Orthop 20:93–103PubMed

14.

Hoffer MM, Stein GA, Koffman M et al (1985) Femoral varus derotation osteotomy in spastic cerebral palsy. J Bone Jt Surg Am 67:1229–1235

15.

Pope DF, Bueff HU, De Luca PA et al (1994) Pelvic osteotomies for subluxation of the hip in cerebral palsy. J Pediatr Orthop 14:724–730PubMedCrossRef

16.

Oh CW, Presedo A, Dabney KW et al (2007) Factors affecting femoral varus osteotomy in cerebral palsy: a long-term result over 10 years. J Pediatr Orthop Part B 16:23–30CrossRef

17.

Khalife R, Ghanem I, El Hage S et al (2010) Risk of recurrent dislocation and avascular necrosis after proximal femoral varus osteotomy in children with cerebral palsy. J Pediatr Orthop Part B 19:32–37CrossRef

18.

Steel HH (1977) Triple osteotomy of the innominate bone. A procedure to accomplish coverage of the dislocated or subluxated femoral head in the older patient. Clin Orthop 122:116–127PubMed

19.

Salter RB, Dubos JP (1974) The first fifteen years’ 271 personal experience with innominate osteotomy in the treatment of congenital dislocation and subluxation of the hip. Clin Orthop 98:72–103PubMedCrossRef

20.

Zimmermann SE, Sturm PF (1992) Computed tomographic assessment of shelf acetabuloplasty. J Pediatr Orthop 12:581–585PubMedCrossRef

21.

Gugenheim JJ, Gerson LP, Sadler C, Tullos HS (1982) Pathologic morphology of the acetabulum in paralytic and congenital hip instability. J Pediatr Orthop 2:397–400PubMedCrossRef

22.

Buckley SL, Sponseller PD, Magid D (1991) The acetabulum in congenital and neuromuscular hip instability. J Pediatr Orthop 11:498–501PubMedCrossRef

23.

Chang CH, Kuo KN, Wang CJ et al (2011) Acetabular deficiency in spastic hip subluxation. J Pediatr Orthop 31:648–654PubMedCrossRef

24.

Canavese F, Emara K, Sembrano JN et al (2010) Varus derotation osteotomy for the treatment of hip subluxation and dislocation in GMFCS level 3 to 5 patients with unilateral hip involvement. Follow-up at skeletal maturity. J Pediatr Orthop 30:357–364PubMedCrossRef

25.

Noonan KJ, Jones J, Pierson J et al (2004) Hip function in adults with severe cerebral palsy. J Bone Jt Surg Am 86-A(12):2607–2613

26.

Shukla PY, Mann S, Braun SV et al (2013) Unilateral hip reconstruction in children with cerebral palsy: predictors for failure. J Pediatr Orthop 33:175–181PubMedCrossRef

Title: One-stage hip reconstruction in children with cerebral palsy: long-term results at skeletal maturity
Authors: Cindy Mallet
B. Ilharreborde
A. Presedo
A. Khairouni
K. Mazda
G. F. Penneçot
Publication date: 01-05-2014
Publisher: Springer Berlin Heidelberg
Published in: Journal of Children's Orthopaedics / Issue 3/2014
Print ISSN: 1863-2521
Electronic ISSN: 1863-2548
DOI: https://doi.org/10.1007/s11832-014-0589-9

At a glance: The STEP trials

Springer Medicine

One-stage hip reconstruction in children with cerebral palsy: long-term results at skeletal maturity

Abstract

Purpose

Materials and methods

Results

Conclusion

Level of evidence

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Materials and methods

Results

Conclusion

Level of evidence

Please log in to get access to this content

Other articles of this Issue 3/2014

Prevalence and pattern of upper limb involvement in cerebral palsy

Posterior spinal fusion to sacrum in non-ambulatory hypotonic neuromuscular patients: sacral rod/bone graft onlay method

Letter to the Editor regarding “Prognostic value of age and Wassel classification in the reconstruction of thumb duplication”

Management of paediatric tibial fractures using two types of circular external fixator: Taylor spatial frame and Ilizarov circular fixator

Nutritional improvement following growing rod surgery in children with early onset scoliosis

The cerebral palsy transition clinic: administrative chore, clinical responsibility, or opportunity for audit and clinical research?