Windblown Hip Deformity and Hip Contractures in Cerebral Palsy

Abstract

Children with cerebral palsy who are not able to ambulate have a high incidence of hip dislocation. This can be prevented with surveillance and early surgical intervention. A small group of these children also develop contracture around the hip joint that can be persistent and difficult to treat. The windblown hip deformity is a condition in which one hip develops adduction, flexion, and internal rotation contracture while the contralateral hip develops abduction, external rotation, and extension contracture. This deformity can lead to difficult seating and limit lying positions. This is often associated with hip dislocation or subluxation on the adducted side. Treatment of the windblown deformity in a young child with normal hips should focus on positioning and stretching. If the hip develops more than 30% subluxation, muscle lengthening is recommended. In children under age 10 years, there is a high risk of the windblown deformity switching sides after surgery, so the surgery should not create a large asymmetry. For older children and adults, the windblown deformity can be managed with muscle lengthening if it is not severe; however, it usually requires femoral osteotomies to create symmetric hip posture. After the skeletal maturity, the deformity tends to remain stable, but often causes functional disability with seating if it is uncorrected.