More than 20 years of experience with Dega transiliac osteotomy in the treatment of dislocated hip joints in children with cerebral palsy

Abstract

Cerebral palsy in children, which is the result of a nonprogressing damage to the central nervous system, causes motor and posture disorders that change with age. The level of child activity correlates with the hip dislocation risk. It most often affects nonwalking patients and those with tetraparesis or oblique pelvis. The aim of the study was to assess the effectiveness and clinical value of Dega pelvic osteotomy with accompanying directional femoral bone osteotomy after minimum of 20 years from surgery of patients with cerebral palsy. The conducted research was retrospective and concerned the children operated at our Hospital. The assessment was carried out in 346 children with spastic hip during the years 1993–2000. The inclusion criteria were applied: unilateral dislocation of the hip, the observation period of at least 20 years, pelvic osteotomy by Dega method and combined with varus derotation femur osteotomy. The analysis involved fifteen patients. The follow-up period was minimum 20 years (20–27 years). The average migration percentage decreased from 88% down to 25%, and an improved range of mobility was observed in the operated joint after surgery. However, the range of mobility was again significantly reduced during the last control examination after a minimum of 20 years. In all hips, the degenerative joint disease was present. Pelvic transiliac osteotomy, according to Dega, with VDRO, ensures very effective correction of the deficit in femoral head coverage by the acetabulum in the upper, lateral and posterior parts. However, it does not prevent the development of the early degenerative disease of the joint.

Long-term outcomes of reconstructive treatment for painful dislocations in patients with cerebral palsy

“…Similarly, our data showed that hip reconstruction gives long-lasting hip stability and significant pain reduction. This is also in keeping with Pruszczyński et al’s 25 findings; however, their report showed that hip reduction did not prevent from early degenerative changes of the hip. Ulusaloglu et al 26 show that residual subluxation (MP ≥ 30.5%) of the femoral head at the time of triradiate cartilage closure negatively affects the head shape and influences the severity of osteoarthritis.…”

Intraoperative medial wall disruption in Dega pelvic osteotomy

“…Several authors reported excellent and satisfactory medium and long-term results of Dega osteotomy. 10,11,[19][20][21][22][23][24][25][26] A recent study that published the results of open reduction, Dega osteotomy, and proximal femoral osteotomy in delayed diagnosis of DDH showed that survival rates were 73% at 40 years in patients who were operated on before the age of 5 years. 24 AI remains a reliable radiographical parameter in the evaluation of acetabular development.…”

Blade plate versus locking plate fixation of proximal femoral varus osteotomy in children with cerebral palsy

“…The debilitating consequences of hip subluxation and dislocation in children with CP are one of the two most common indications for proximal femoral varus derotational osteotomy (VDRO), with the other indication being femoral anteversion secondary to muscle imbalance in children with CP [6]. Not uncommonly, a pelvic osteotomy is performed in addition to a proximal femoral VDRO as this has been shown to effectively correct the deficit in femoral head coverage often seen in this patient population [7,8]. In addition to the common complications associated with all surgeries such as blood loss and nerve damage, a feared long-term complication of hip reconstruction is avascular necrosis of the femoral head.…”