Surgical treatment of subluxation and dislocation of the hips in cerebral palsy patients

Abstract

Background and purpose: Progressive subluxation and dislocation of the hip are major complications in patients with cerebral palsy (CP), causing functional deterioration and difficulties in personal hygiene. Treatment of these problems is difficult and complicated. The purpose of this study was to describe the surgical results and long-term follow-up in a group of CP patients.

Methods: Twenty-three CP patients with subluxated (15 hips) or dislocated hips (12 hips) underwent corrective surgery between 1985 and 1993. This included 11 quadriplegic, eight diplegic, and four hemiplegic patients. Before surgery, four patients were bed-ridden, eight were sitters, six were house-ambulators, and five were community-ambulators. The average age at surgery was 8 years and 5 months. The surgical procedures consisted of femoral varus derotational osteotomy in 21 patients (25 hips), selected soft tissue release in 18 patients (22 hips), and pelvic osteotomy in 18 patients (20 hips). The center-edge angle, acetabular index, and neck-shaft angle were used as parameters to evaluate preoperative and postoperative radiographic changes.

Results: After an average follow-up of 4.8 years, 19 patients (22 hips) had gained hip stability, and also had improved functional status. The four bed-ridden patients all became sitters; six of the eight sitters became house-ambulators and one became a community-ambulator; all six house-ambulators became community-ambulators, and the five community-ambulators had functional improvement. Complications included nonunion at the femoral osteotomy site in one hip, redislocation in two hips, and resubluxation in one hip.

Conclusions: We conclude that subluxated or dislocated hips in patients with CP can be effectively treated with aggressive correction, which may include soft tissue release, femoral derotational osteotomy, and pelvic osteotomy for improvement of hip range of motion and functional status.