Hip Reconstruction in Children with Cerebral Palsy

Abstract

Children with cerebral palsy who are not able to ambulate have a high frequency of developing hip subluxation and dislocation. Through early surveillance, many of these can be treated before there is pain or severe hip displacement and deformity. After the initial early detection, or if the problem is discovered later with more severe hip displacement, a full hip reconstruction is required. This procedure usually involved lengthening of the hip adductor muscles, femoral varus osteotomy. When there is hip subluxation or dislocation with acetabular dysplasia, a pelvic osteotomy is also required. It is usual to do bilateral, femoral osteotomies to prevent the problems of seating caused by very symmetric leg lengths, to treat the contralateral abducted hip to prevent it from causing seating problems and from driving the opposite hip back to adduction and recurrent dislocation. This reconstruction can usually be done without the use of casts, and the child can be up in the wheelchair in 2--4 days. Long-lasting correction of the hip displacement has approximately a 95% success; relief of pain when it is present before surgery occurs in more than 90% of children. Good results of reconstruction have been reported in young adults, although good outcomes are less common with very young children and in adults when the hip is completely dislocated.