Indications of orthopedic surgical treatment on bones in the hip region in patients with cerebral palsy
Abstract
Introduction. Procedure on bones in the area of hip joints in patients with cerebral palsy is indicated according to the degree of lateral migration in the area of proximal femur and pelvis, sometimes in combination with open surgical reposition.
Material. In the years 1999-2002, the following bone surgeries in the hip joint area were performed at the Orthopedic Clinic, 2(nd) Medical Faculty, Charles University: improvement of centration, 53 hip joints in 32 patients; a palliative procedure, 22 hip joints in 14 patients with cerebral palsy.
Methods. The operative approaches include isolated and combined procedures on bones ranging from correction of anteversion or combination with a procedure on pelvis, possibly with an open surgical reposition, to palliative procedures.
Subsequent post-surgery evaluation was clinical and X-ray-based, according to the migration percentage and Wiberg CE angle 2 and 6 months after surgery. Results: In marginal and high luxation, the best results were achieved in reconstruction of the hip joint under age of 9 years.
In 2 patients (2 joints), re-luxation occurred between 6-12 months after surgery, which represents 12.2 % from a total of 16 complete procedures. In de-rotation subtrochanteric osteotomies, clinical findings always improved and Wiberg CE angle increased on average by 10 %.
In palliative Schanz osteotomy, postoperative improvement of the range of motion occurred in all patients. Occasional pain was subsequently reported by 2 patients (2 hip joints).
Out of the total of 22 palliative procedures, this represents 9.1 %. Discussion.
Procedures on bones in the hip joint area in patients with cerebral palsy are procedures following those on muscles, or they may be combined simultaneously. Complete reconstruction surgeries have to be indicated in the first decade of life, when the shape of the femoral head is not changed and the joint socket does not disappear.
In patients over the age of 10 with high luxation, it is sometimes necessary to indicate palliative procedures because of pain and to enable improved care.