Author:
Chen Kangming,Wu Jinyan,Shen Chao,Zhu Junfeng,Chen Xiaodong,Xia Jun
Abstract
Abstract
Background
This study is aimed to investigate retrospectively the radiographic and clinical outcomes in children and young adults with cerebral palsy (CP) undergoing periacetabular osteotomy (PAO) with or without femoral osteotomy (FO) for hip subluxation.
Methods
A consecutive cohort of twenty-one patients (23 hips) with symptomatic CP hip subluxation were treated with PAO with or without FO and reviewed retrospectively. Two patients (2 hips) were excluded due to insufficient follow-up and lost to follow-up, respectively. The Reimers migration percentage, lateral center-edge angle (LCEA), Sharp angle, neck-shaft angle (NSA), femoral anteversion (FNA), Gross Motor Function Classification System (GMFCS) and hip pain were assessed.
Results
Twenty-one hips (19 patients) with CP treated with PAO with or without FO were included. Five hips received PAO. Sixteen hips underwent PAO with FO. Mean age at surgery was 19 ± 6 and 15 ± 4 years for PAO and PAO plus FO, respectively. Mean follow-up was 44.0 ± 28.3 months for PAO and 41.5 ± 17.2 months for PAO + FO. All hips were painful before surgery and painless at final visits. The GMFCS improved by one level in 10 of 19 patients. There was significant increase in LCEA (p < 0.001) and decrease in the Reimer’s MP (p < 0.001), NSA (p < 0.001) and Tonnis angle(p < 0.001) postoperatively. Resubluxation occurred in 7 hips (30%) due to insufficient correction and loosening of fixation. Nervus cutaneus femoris lateralis was impaired in 4 patients after surgery. There was no avascular necrosis of the femoral head, resubluxation or infection.
Conclusion
PAO with or without FO can be effective for children and young adults with concomitant hip subluxation and CP.
Funder
National Natural Science Foundation of China
Publisher
Springer Science and Business Media LLC
Subject
Orthopedics and Sports Medicine,Rheumatology
Reference37 articles.
1. Chung MK, Zulkarnain A, Lee JB, Cho BC, Chung CY, Lee KM, et al. Functional status and amount of hip displacement independently affect acetabular dysplasia in cerebral palsy. Dev Med Child Neurol. 2017;59(7):743–9.
2. Bagg MR, Farber J, Miller F. Long-term follow-up of hip subluxation in cerebral palsy patients. J Pediatr Orthop. 1993;13(1):32–6.
3. McNerney NP, Mubarak SJ, Wenger DR. One-stage correction of the dysplastic hip in cerebral palsy with the San Diego acetabuloplasty: results and complications in 104 hips. J Pediatr Orthop. 2000;20(1):93–103.
4. Al-Ghadir M, Masquijo JJ, Guerra LA, Willis B. Combined femoral and pelvic osteotomies versus femoral osteotomy alone in the treatment of hip dysplasia in children with cerebral palsy. J Pediatr Orthop. 2009;29(7):779–83.
5. Cooke PH, Cole WG, Carey RP. Dislocation of the hip in cerebral palsy. Natural history and predictability. J Bone Joint Surg Br. 1989;71(3):441–6.