Degaʼs Transiliac Osteotomy in the Treatment of Spastic Hip Subluxation and Dislocation in Cerebral Palsy

Jóźwiak, Marek; Marciniak, W; Piontek, Tomasz; Pietrzak, Szymon

doi:10.1097/01202412-200010000-00009

Cited by 51 publications

(28 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This finding is consistent with previous literature, and can be explained by (1) imbalance between the spasticity of psoas and adductor muscles and (2) gluteus medius muscle weakness [5, 14, 15]. Nevertheless, the gradual migration of the femoral head was moderate [16], with 85 % of the hips maintaining a Reimers index <30 % at skeletal maturity.…”

Section: Discussionsupporting

confidence: 91%

“…Radiological results were satisfactory, with only 10 % of recurrence of subluxation or dislocation at skeletal maturity, and consistent with the results published in the literature, ranging from 7 % to 23 % [4–6, 13]. However, Sankar et al [4] and Jozwiack et al [5] systematically performed an open reduction and associated capsulorrhaphy, while McNerney et al [13] recommended open reduction associated with capsulorrhaphy in case of Reimers >70 %. Their results are comparable to those described here.…”

Section: Discussionsupporting

confidence: 86%

“…In older patients, one-stage reconstruction procedures associating femoral varus derotation and shortening osteotomy (VDRSO) and pelvic osteotomy are considered to be the most appropriate treatment [2–6]. In addition, some authors have advocated associating open reduction and capsulorrhaphy in case of hip dislocation [2–5] despite the risk of femoral head avascular necrosis (AVN).…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

One-stage hip reconstruction in children with cerebral palsy: Long-term results at skeletal maturity

Mallet¹,

Ilharreborde²,

Presedo³

et al. 2014

Journal of Children's Orthopaedics

View full text Add to dashboard Cite

PurposeHip subluxation is common in children with cerebral palsy (CP). Surgery is indicated in case of pain or progressive increase of Reimers index on radiographs. Peri-iliac osteotomy combined with femoral osteotomy is one of the numerous operative techniques available, but results at skeletal maturity remain unclear. The purpose of this radiological study was to report the long-term results of this procedure.Materials and methodsTwenty hips in 20 children were retrospectively evaluated at skeletal maturity. Mean age at surgery was 8.1 years and follow-up averaged 9.1 years. All patients underwent Dega acetabuloplasty, soft-tissue release and femoral-shortening varus derotation osteotomy without open reduction. Reimers index, acetabular angle (AA) and neck-shaft angle (NSA) were compared on preoperative, postoperative and latest follow-up radiographs.ResultsDega osteotomy significantly improved the AA and the correction remained stable at maturity. The NSA significantly decreased postoperatively (153°–115°), but recurrence of the valgus deformity (130°) of the proximal femur was observed at maturity. Consequently, Reimers index followed the same evolution. No case of osteonecrosis was reported but one hip dislocated and one subluxated during follow-up.ConclusionProgressive recurrence of the valgus deformity of the proximal femur, attributable to adductors spasticity and gluteus medius weakness, led to a significant increase in the Reimers index. However, hip coverage remained >70 % at maturity in 90 % of the hips. This one-stage procedure without hip dislocation efficaciously corrected acetabulum dysplasia and successfully treated neurological hips in CP patients.Level of evidenceIV: retrospective study.

show abstract

Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 86%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

One-stage hip reconstruction in children with cerebral palsy: Long-term results at skeletal maturity

Mallet¹,

Ilharreborde²,

Presedo³

et al. 2014

Journal of Children's Orthopaedics

View full text Add to dashboard Cite

show abstract

“…1,2 The acetabular defects in cerebral palsy differ from those in developmental dysplasia of the hip (DDH) and posterior, anterior, superior and global wall defects have been reported. [2][3][4][5] In a previous study, 6 we carried out a morphometric analysis of the acetabulum in patients with cerebral palsy.…”

mentioning

confidence: 99%

Morphometric changes in the acetabulum after Dega osteotomy in patients with cerebral palsy

Chung

et al. 2008

The Journal of Bone and Joint Surgery. British volume

View full text Add to dashboard Cite

We carried out a morphometric analysis of the acetabulum following Dega osteotomy in patients with cerebral palsy using three-dimensional CT. We assessed 17 acetabula in 12 patients with instability of the hip. A Dega osteotomy and varus derotation femoral osteotomy were performed in all 17 hips. Three-dimensional CT scans were taken before and approximately one year after operation. Acetabular cover was evaluated using anterosuperior, superolateral and posterosuperior acetabular indices, and the change in the acetabular volume was calculated. Inter-and intra-observer reliability was assessed using the intraclass correlation coefficient. After the osteotomy, the anterosuperior, superolateral and posterosuperior cover had improved significantly towards the value seen in a control group. The mean acetabular volume increased by 68%.

show abstract

“…Pelvic osteotomy has been successfully used to treat both acetabular dysplasia [1,5,6] Legg-Calve-Perthes disease [2] and hip subluxation in cerebral palsy [6,7], with satisfactory results in the literature. It is essential during the procedure to obtain a more horizontal sourcil with improved cover of the femoral head.…”

Section: Discussionmentioning

confidence: 98%

Intraoperative assessment of acetabular orientation

Gallacher

Roberts²

2012

Journal of Pediatric Orthopaedics B

View full text Add to dashboard Cite

Acetabular surgery is frequently utilized to manage developmental dysplasia of the hip and hip problems associated with cerebral palsy. During the operation, accurate correction of the orientation of the acetabular fragment is necessary. We describe a technique that enables accurate assessment of the coronal plane alteration in orientation. Intraoperative image intensifier records were compared with postoperative films and the accuracy of the coronal plane correction was evaluated. We found the intraoperative sourcil angle closely correlated to the postoperative angle to within 1°. The Spearman correlation coefficient was R=0.97, suggesting a close relationship between the two measurements.

show abstract

Degaʼs Transiliac Osteotomy in the Treatment of Spastic Hip Subluxation and Dislocation in Cerebral Palsy

Cited by 51 publications

References 0 publications

One-stage hip reconstruction in children with cerebral palsy: Long-term results at skeletal maturity

One-stage hip reconstruction in children with cerebral palsy: Long-term results at skeletal maturity

Morphometric changes in the acetabulum after Dega osteotomy in patients with cerebral palsy

Intraoperative assessment of acetabular orientation

Contact Info

Product

Resources

About