Abstract
Purpose of the study: Derotational subtrochanteric osteotomy as an independent surgical procedure is one of the options for treatment of hip anteversion in adolescent patients with cerebral palsy. In other indications it is one of combined surgical procedures for hip joint reconstruction.
Material: During the 1992-2005 period, derotational subtrochanteric osteotomy was indicated in 74 cases, in ambulatory patients 9 to 18 years old, with diplegic or hemiplegic cerebral plasy. In 63 cases it was used a part of combined surgery.
Methods: The postoperative evaluation was based on clinical and radiographic findings, migration rates and Wiberg's CE angle obtained at 2 and 6 months, and then at each 6 months following surgery. Results: Derotational subtrochanteric osteotomy alone always resulted in improvement of clinical status and an increase in Wiberg's CE angle by 10 degrees on average.
Patients with marginal or high dislocation showed best results when the hip joint was reconstructed before the age of 9 years. In three hips a recurrent dislocation occurred gradually within one year of surgery.
These patients fell back to stage II of the Vojta classification found preoperatively. During the next three years, three more hips developed a recurrent dislocation and two showed lateralization (20 %).
Discussion: Reconstructive surgery for neurogenic dislocation in patients over 10 years of age is associated with problems, as is derotation combined with varus osteotomy in abductor insufficiency. On the other hand, derotational subtrochanteric osteotomy alone is indicated particularly in children over 10 years, in whom it corrects hip joint anteversion and improves gait.
Conclusions: Complete reconstructive procedures should be considered in the first 10 years of life when neither the femoral head nor the acetabulum are markedly changed. Derotative osteotomy alone is preferred to procedures combined with varus osteotomy.
In walking adolescent patients, derotative femoral osteotomy alone is recommended; this can exceptionally be used at earlier age if marked asymmetry is present.