Varus derotation osteotomy for the treatment of hip subluxation and dislocation in GMFCS level III-V patients with unilateral involvement: follow-up at skeletal maturity

Varus derotation osteotomy for the treatment of hip subluxation and dislocation in GMFCS level III-V patients with unilateral involvement: follow-up at skeletal maturity
F CANAVESE MD, MD SUSSMANMD
Pediatric Orthpedics Surgery, Shriners Hospital, Portland, OR, USA

Background/objectives: Hip displacement is common in children with cerebral palsy(CP).the risk of hip displacement is directly related to gross motor function level as graded with the gross motor function classification system(GMFCS).Surgical treatment is indicated for progressive hip subluxation in skeletally immature CP patients GMFCS III-V. However it is unclear whether unilateral bony surgery and musculotendons release is effective in cases where the contralateral hip is well seated. The purpose of this study is to describe the fate of the original and the contralateral hip of severely involved, non –ambulatory CP patients with unilateral hip subluxation or dislocation treated with unilateral femoral osteotomy (VDRSO) ± pelvic osteotomy (PO) along with unilateral or bilateral soft tissue release. Furthermore we wanted to see if short term outcomes were maintained when patients were followed to skeletal maturity.
Design: Retrospective study.
Participants and Setting: Twenty-seven GMFCS III-V CP patients with unilateral hip subluxation or dislocation were followed from the time of presentation until skeletal maturity.
Materials/Methods: A continous group of 27 GMFCS III to V CP patients with unilateral hip subluxation or dislocation [ III: 2 pts.(7.4%),IV:5pts.(18.5%), V: 20 pts. (74.1%)] underwent soft tissue release and VDRSO with or without PO. All patients were clinically and radiologically followed from the time of presentation until skeletal maturity.
Results: At the time of chart and radiograph review, the average age of this patient group was 20.4 year (range: 14-25). OF the 27 patients with unilateral hip subluxation or dislocation 22(81.5%) were treated with adductor and ileopsoas release and VDROS and 5(18.5%) with a combination of soft tissue release, VDRSO and PO. Twelve patients(44%) required surgical management of the contralateral hip which eventually subluxated or dislocated during follow-up .Nine of them (75%) were treated with VDRSO alone and 3(25%) patients had revision of the first hip and at the same time had bony correction of the contralateral hip.
Conclusions/Significance: the rates of recurrence of the original hip as well as contralateral hip subluxation and dislocation following unilateral bony surgery in GMFCS III-V CP patients are higher then those of other previous series. However, in this series patients were followed until skeletal maturity. Age at surgery did not appear to have a significant effect on maintaining reduction or in preventing the contralateral hip to deteriorate. It is prudent to warn families of the possibility of long term subluxation or dislocation of the original hip as well as development of the hip dysplasia requiring surgery on the contralateral side. Consideration should be given to adductor and ileopsoas release and bony surgery on the contralateral side in a GMFCS level III-V child undergoing surgery for hip displacement, even when the hip appear radiologically normal. Close radiological follow-up of both hips is recommended.

 
Gallery
Gal 1 Gal 2
Supporting Organizations
 
   
   
   
 
Online Feature Partner
 
   
   
 
Locations of visitors to this page
 
 

© 2010 all rights reserved. maintained by Classic Infomedia