Long-term follow-up after one-stage reconstruction of dislocated hips in patients with cerebral palsy

Abstract

Twelve consecutive patients (average age 10.6 years) with 14 dislocated hips underwent one-stage hip reconstruction between 1973 and 1981. The procedure consisted of (1) adductor myotomy and anterior obturator neurectomy, (2) circumferential capsulotomy, iliopsoas and external rotator tenotomies, and ligamentum teres and pulvinar excision, (3) shortening femoral varus derotational osteotomy, (4) acetabuloplasty, and (5) spica immobilization for 4 weeks. All patients were followed clinically and radiographically at an average of 16.7 (range 12.4-19.5) years. No patients were lost to follow-up. Long-term results revealed complete stability in 13 of 14 hips, with no redislocations or subluxations. The one patient with "instability" had undergone bilateral proximal femoral resections for severe arthritis 12 years after left hip reconstruction; at the time of resection, the left hip was stable and reduced. Pain was absent in 13 of 14 hips. There were no problems with perineal care, decubitus formation, or sitting tolerance. Extension and abduction improved an average of 23 degrees and 10 degrees, respectively. Two patients' ambulatory status improved; none deteriorated. The mean center-edge angle was 35 degrees (range 22-50 degrees), and the mean migration percentage was 10.6% (range 0-31%). Complications included one case of degenerative arthritis, one case of painless coxa vara, and three episodes of supracondylar femur fractures. None of these patients developed radiographic evidence of avascular necrosis. In the authors' experience, one-stage hip reconstruction consisting of soft tissue lengthening, open reduction, femoral osteotomy, and pericapsular acetabuloplasty results in a painless, mobile, and stable hip at long-term follow-up that greatly improves the patient's quality of life.