Short-Term Results of Musculotendinous Release for Paralytic Hip Subluxation in Children with Spastic Cerebral Palsy

Abstract

INTRODUCTIONChildren with paralytic hip subluxation secondary to spastic cerebral palsy were treated with a standard protocol that depended on early detection of the subluxation using clinical examination detecting limited range of hip abduction of ≤ 30° and anteroposterior pelvis radiographs detecting subluxation ≥ 33% migration as indications.PATIENTS AND METHODSPatients underwent open adductor longus, proximal gracilis and proximal rectus femoris myotomy, and iliopsoas lengthening with immediate postoperative immobilisation in abduction bar for 3 weeks followed by physiotherapy. The protocol was applied to 50 children with a mean age of 3.6 years with 100 hips surgically corrected. Of these hips initially, 52% were mildly subluxated with ≤ 33% migration, 42% were moderately subluxated with > 33–66% migration, and 6% were severely subluxated with > 66% migration.RESULTSAt a final postoperative follow-up of at least 24 months, 22% of these hips were classified as excellent with full containment and no migration, 54% were good with < 20% migration, and 24% were fair with 20–25% migration. No poor result with > 25% migration was obtained. No child developed an abduction contracture or wide-based gait that required treatment.CONCLUSIONSEarly detection and application of this treatment algorithm for children with spastic hip disease should have satisfactory outcomes. Longer follow-up will be required to determine how many children will need bony reconstruction to maintain stable containment of hips at maturity.