Two-stage surgery in the treatment of spastic hip dislocation--comparison between early and late results of open reduction and derotation-varus femoral osteotomy combined with Dega pelvic osteotomy preceded by soft tissue release.

Abstract

BACKGROUND:

Authors present and compare early and late results of treatment of spastic hip dislocation in cerebral palsy patients.

MATERIAL AND METHODS:

We analyzed a group of 77 patients (109 hips) with hip joint dislocation (MP>80%). The patients were divided into two groups: <3 years of follow-up vs. > 3 years of follow-up. The first group thus included 64 hips (47 patients) with mean follow-up duration of 2.2 years (range 1.1-3), and the second group had 45 hips (30 patients) with mean follow-up duration of 4.8 years (range 3.2-10.2). The hips were evaluated clinically and radiographically. The relation of the femoral head to the acetabulum was described as the Acetabular Index (AI) and Reimers' migration percentage (MP).

RESULTS:

In Group I, AI improved from 32.2°(17°-50°) to 22.2°(6°-45°), MP improved from 98.9% (82%-100%) to 15.9% (0%- 100%). In Group II, AI improved from 28.9° (10°-62°) to 19.4° (3°-50°). The changes in AI and MP were statistically significant. Group I demonstrated a reduction in the flexion contracture from 21.1° (0°-50°) to 10.7° (0°-30°), an increase in abduction from 19.5° (0°-60°) to 29.9° (0°-60°), and a decrease in the popliteal angle from 52.0° (0°-100°) to 34.2° (0°-85°). Group II showed a reduction in the flexion contracture from 24.6° (0°-60°) to 12.6° (0°-40°), an increase in abduction from 17.3° (-25°-80°) to 26.1° (-15°-80°), and a decrease in the popliteal angle from 61.4° (0°-120°) to 40.7° (10°-100°). These improvements were statistically significant.

CONCLUSION:

Open reduction of the hip joint combined with derotation-varus femoral osteotomy and Dega pelvic osteotomy is a very effective treatment in spastic hip joint dislocation. We observed no statistically significant deterioration of results between the groups.

• Authors: Marek Jóźwiak, Aleksander Koch
• Journal: Ortopedia, traumatologia, rehabilitacja (Ortop Traumatol Rehabil) 2011 Mar-Apr Vol. 13 Issue 2 Pg. 144-54 ISSN: 2084-4336 [Electronic] Poland
• PMID: 21602581 (Publication Type: Comparative Study, Journal Article)

Topics

• Cerebral Palsy (complications)
• Child
• Female
• Femur (diagnostic imaging, surgery)
• Hip Dislocation (diagnostic imaging, etiology, surgery)
• Humans
• Infant
• Male
• Muscle Spasticity
• Osteotomy (methods)
• Pelvis (diagnostic imaging, surgery)
• Radiography
• Treatment Outcome