Proximal femoral resection and articulated hip distraction with an external fixator for the treatment of painful spastic hip dislocations in pediatric patients with spastic quadriplegia

Abstract

We describe the results obtained with an alternative method of treatment for spastic painful hip dislocations in nonambulatory patients, which consists of a proximal femoral resection with capsular interposition arthroplasty, and the addition of a hinged external fixator for postoperative articulated hip distraction to allow for an immediate upright position and the ability to sit in a wheelchair. We performed this technique in three patients (four hips) with a mean age at the time of surgery of 15 years. Postoperatively, clinical improvement was observed in all four hips, with respect to pain relief, sitting tolerance, perineal care and functional range of motion.

Proximal femoral resection without post-operative traction for the painful dislocated hip in young patients with cerebral palsy

“…4,5 Proximal femoral resection (PFR) has been described in the literature and is considered a good treatment for children with pain. [2][3][4][6][7][8][9] In 1978, Castle and Schneider 3 were among the first to describe the technique, and variations on their method have been reported subsequently. 3,6-10 Unlike a Girdlestone resection arthroplasty, for a PFR the proximal femur must be resected distal to the lesser trochanter.…”

“…4,10 The main complications of this procedure are proximal migration of the femur causing femoropelvic impingement; regrowth of the bone; and heterotopic ossification. 2,3,6,9,11 Extra-periosteal resection is recommended to prevent regrowth and heterotopic ossification. Post-operative traction has been recommended to prevent proximal migration.…”

“…The recommended duration of traction varies from two to 12.8 weeks. 6,7 Various methods of interpositional grafting have been described, 3,7,8,10 and alternative methods of immobilisation involving, for instance, external fixators and spica casts 7,9,10 have also been described. The complications of these methods include skin breakdown and decubitus ulcers, pin-site infections, stiffness, and respiratory and urinary tract infections.…”

McHale Operation in Patients with Neglected Hip Dislocations: The Importance of Locking Plates

“…However, neglected hip displacement is still common in severely disabled patients with cerebral palsy. Surgical treatment for neglected hip dislocations includes constructive or salvage procedures, from total hip arthroplasty [16], to hip reconstruction [6,7], subtrochanteric valgus osteotomy without resection of the femoral head [13], resection of the femoral head [9,28,29], resection of the femoral head with articulated hip distraction [30], and subtrochanteric valgus osteotomy with femoral head resection [11,12]. Arthrodesis [14] is another option for nonreconstructible hips.…”

A hip resurfacing implant in an adolescent with cerebral palsy

“…This usually involves a combination of femoral and pelvis osteotomies [4]. Proximal femoral resection is also a recognized technique for dealing with painful dislocated hips with or without an initial period of articulated hip distraction [5]. The aims of operative intervention in patients with dislocated hips in cerebral palsy are pain relief, improved seating, perineal hygiene and carer satisfaction [6].…”