Hip-joint congruity after Dega osteotomy in patients with cerebral palsy: long-term results

Braatz, Frank; Staude, Daniel; Klotz, Matthias; Wolf, Sebastian I.; Dreher, Thomas; Lakemeier, Stefan

doi:10.1007/s00264-015-3013-2

Cited by 22 publications

(8 citation statements)

References 37 publications

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“…The CE angle also increased after surgery, suggesting a better coverage of the acetabulum over the femoral head. This replicates the findings of previous studies [ 30 , 31 ]. Although this is partly attributed to the pelvic osteotomy, some previous reports have suggested that femoral osteotomy itself may have some effects on acetabular development [ 32 , 33 ].…”

Section: Discussionsupporting

confidence: 93%

“…This may be due to forces acting on the femoral head from the lateral portion of the acetabulum and the surrounding muscles. Braatz et al [ 29 , 30 ] reported that even when the femoral head is deformed pre-operatively, the plasticity of the hip joint allows for the remodelling of the femoral head from aspherical to spherical. Braatz et al [ 29 , 30 ] also reported an improvement in congruency of the hip joint after surgery, with a further improvement at the long-term follow-up.…”

Section: Discussionmentioning

confidence: 99%

“…Braatz et al [ 29 , 30 ] reported that even when the femoral head is deformed pre-operatively, the plasticity of the hip joint allows for the remodelling of the femoral head from aspherical to spherical. Braatz et al [ 29 , 30 ] also reported an improvement in congruency of the hip joint after surgery, with a further improvement at the long-term follow-up. The congruency was measured according to the difference between the medial and lateral joint gap.…”

Section: Discussionmentioning

confidence: 99%

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Long-Term Evolution of the Hip and Proximal Femur after Hip Reconstruction in Non-Ambulatory Children with Cerebral Palsy: A Retrospective Radiographic Review

Tischhauser

Camathias

et al. 2022

Children

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Background: Hip displacement in children with cerebral palsy (CP) has a higher prevalence in non-ambulatory children. Progression can lead to pain, pelvic obliquity and difficulty with sitting. This can be addressed with hip reconstruction. Our study aims to report the long-term radiological outcomes after hip reconstruction, in particular the evolution of femoral head deformity. Methods: A total of 58 hips of non-ambulatory children with CP were evaluated retrospectively using pre-operative, early (median 120 days) and late post-operative (median 8.6 years) anteroposterior standardised radiographs. All the hips were treated with femoral shortening varus derotation osteotomy (VDRO), pelvic osteotomy and an open reduction, if indicated. The radiographical indices measured included the migration percentage (MP), sharp angle, acetabular index, centre-edge angle, neck shaft angle, head shaft angle, pelvic obliquity, femoral head sphericity, femoral head deformity (FHD) and growth plate orientation. Results: Improvements in hip congruency and morphology were evident after reconstructive hip surgery. These were maintained at the late post-operative time point. Median MP improved from 56% (IQR 46–85%) to 0% (IQR 0–15%) at early follow-up. This increased to 12% (IQR 0–20%) at late follow-up. Pre-operatively, FHDs of 14 hips (24%) were classified as grade A (spherical femoral head). This increased to 22 hips (38%) at early follow-up and increased further to 44 hips (76%) at late follow-up. Conclusions: Our study shows that hip reconstruction reduces hip displacement in the long term, indicated by decreased post-operative MP maintained at long-term follow-up. Although non-ambulatory children lack weight-bearing forces promoting bone remodelling, improved femoral head morphology after surgery alters the forces between the acetabulum and the femoral head. Mild femoral head deformity (grades A and B) remained stable and even improved after surgery, postulated to be due to severe osteoporosis allowing remodelling.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Long-Term Evolution of the Hip and Proximal Femur after Hip Reconstruction in Non-Ambulatory Children with Cerebral Palsy: A Retrospective Radiographic Review

Tischhauser

Camathias

et al. 2022

Children

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“…A total of 95% of the hips remained reduced and there were no redislocations. Braatz et al 33 reported the outcomes after the combined procedure in 72 hips in patients with cerebral palsy. In their study, at a mean follow-up of 7.7 years, 89% of hips had an MI less than 30%, which is similar to a another previous report.…”

Section: Discussionmentioning

confidence: 99%

Combined pelvic and femoral reconstruction in children with cerebral palsy

et al. 2017

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ObjectiveThe primary aim of this study was to determine the effect of age, femoral head migration, and ambulatory status on radiographic outcomes after combined pelvic and femoral reconstruction in children with cerebral palsy. The secondary aim was to evaluate the fate of the opposite hip after unilateral reconstruction.MethodsA retrospective cohort study design of consecutive patients from 1995–2009 was used. The records were screened for patients who underwent varus derotational osteotomy and modified Dega osteotomy.ResultsEighty-five hips in 71 patients were included. The mean age was 8.4 ± 3.2 years and the mean follow-up was 6.6 ± 3.1 years. The final measures were a mean migration index of 20% ± 15.58%, centre edge angle of 28.45° ± 15.98°, and Sharp’s angle of 40.75° ± 8.5°. Those values were not correlated with age and the initial migration index. Nonambulatory status did not negatively affect hip stability. Final measurements of the contralateral hips were similar to the reconstructed hips, and the cumulative incidence for later reconstruction was 5.67%.ConclusionsRegardless of age, preoperative displacement, and ambulation, the combined procedure provides durable radiographic improvement. In unilateral cases, there is a low risk of later deterioration of the opposite side.

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“…Orthopedic surgery can roughly be divided into tendon lengthening, tendon transfer, osteotomy, and arthrodesis. The indications include fixed contracture, joint deformity, joint dislocation, and subluxation that affect function or cause pain [18][19][20][21][22]. Furthermore, the purpose of surgery is to improve motor function, prevent deformity, relieve pain, and modify the appearance of patients [23,24].…”

Section: Surgical Managementmentioning

confidence: 99%

Orthopedic treatment of the lower limbs in spastic paralysis

Deng

Zeng

et al. 2020

Brain Science Advances

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Spastic paralysis of the limb mainly results from the central lesion, in which spastic cerebral palsy is the common cause. Due to durative muscle spasm in spastic cerebral palsy, it is often accompanied by the formation of secondary musculoskeletal deformities, resulting in limb motor disability. Based on its pathogenesis, surgical treatment is currently applied: selective posterior rhizotomy (SPR) or orthopedic surgery. The primary purpose of early orthopedic surgery was simply to correct limb deformities, which usually led to the recurrence of deformity as a result of the presence of spasticity. With the application of SPR, high muscle tone was successfully relieved, but limb deformity was still present postoperatively. Therefore, this study aimed to elaborate on the management of orthopedic surgery, common deformities of the lower limb, and orthopedic operative methods; discuss the relationship between SPR and orthopedic procedure for limb deformity; and focus on the indications, timing of intervention, and postoperative outcome of different surgical methods.

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Hip-joint congruity after Dega osteotomy in patients with cerebral palsy: long-term results

Abstract: Data of our study with high plasticity of the hip joint suggest that even if the femoral head is deformed and a persistent incongruency after surgery is expected, hip reconstruction can be recommended.

Cited by 22 publications

References 37 publications

Long-Term Evolution of the Hip and Proximal Femur after Hip Reconstruction in Non-Ambulatory Children with Cerebral Palsy: A Retrospective Radiographic Review

Long-Term Evolution of the Hip and Proximal Femur after Hip Reconstruction in Non-Ambulatory Children with Cerebral Palsy: A Retrospective Radiographic Review

Combined pelvic and femoral reconstruction in children with cerebral palsy

Orthopedic treatment of the lower limbs in spastic paralysis

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