Palliative or Salvage Hip Management in Children with Cerebral Palsy

Abstract

Some children with cerebral palsy are at risk for hip dislocation during childhood. These dislocated hips can cause pain and limited hip motion making sitting, standing, and walking difficult. The treatment for this condition should start with early identification and early treatment. If this fails the hips should have a bony reconstruction which will in almost all cases resolve the dislocation. However, if this early treatment was not performed, the hips may become dislocated and develop severe arthritis with pain and limited movement. The initial treatment in this late-stage degeneration is to decrease hip movement and standing as much as possible and use anti-inflammatory medication. If this still does not resolve the pain or stiffness, surgery is required. For children and adults who have functional ambulatory ability, a standard total hip replacement is the best option. For children or adults who do not ambulate, the options include resecting the proximal femur and placing an interposition prosthesis usually a shoulder prosthesis. This tends to give quick pain relief and improved motion; however, there is a risk of infection. For smaller children, femoral resection with covering or the femur with bone cement is another option. Some surgeons choose to remove only the femoral head; however, this has a high failure rate. Removing the proximal femur (Castle procedure) and placing in a cast or traction will usually yield a good outcome over time; however, it requires up to 1 year for the pain to resolve. In conclusion, the primary effort should focus toward preventing dislocated hips, because the options to address the problem in end-stage disease are more limited with less optimal outcome.