Subtrochanteric Valgus Osteotomy for Chronically Dislocated, Painful Spastic Hips

ABBREVIATIONS BoNT-A Intramuscular botulinum toxin-A VAS Visual analogue scale ITB Intrathecal baclofen AIM To determine the efficacy of interventions for the management of pain in children and adolescents with cerebral palsy (CP). METHOD Electronic databases were searched from the earliest date possible to April 2018 using a mixture of subject headings and free text. Inclusion criteria comprised of studies with (1) diagnosis of CP, (2) under the age of 18 years, (3) intervention for the management of pain, (4) outcome measure of pain, and (5) studies published in English-language peerreviewed journals. RESULTS Fifty-seven studies met the eligibility criteria. Pain related to (n=number of studies): hypertonia (n=17), spastic hip disease (n=13), procedures for the management of CP (n=7), postoperative (n=18), and other (n=2). Most of the studies were of level III to level V evidence.

Section: Resultsmentioning

confidence: 99%

“…Postoperative pain after selective dorsal rhizotomy surgery related exclusively to individuals with spastic diplegia . Of all eligible studies, seven studies had a mixed population including participants with CP and participants with other diagnoses (Table SVI, online supporting information) …”

Section: Resultsmentioning

confidence: 99%

Management of pain in children and adolescents with cerebral palsy: a systematic review

Ostojic

Paget

Morrow

2018

“…The reported incidence of pain in hips that are dislocated varies from 20 to 80%. 21,22 A significant number of dislocated hips are eventually managed by some form of salvage surgery, including valgus osteotomy, 23 resection of the femoral head and part of the proximal femur, 24 combined valgus osteotomy with proximal femoral resection, 25 arthrodesis of the hip, and various forms of replacement arthroplasty. 26 The common feature of all of these forms of salvage surgery is loss of the hip joint.…”

Section: Methods Qualitative Methodologymentioning

confidence: 99%

A classification system for hip disease in cerebral palsy

Robin

Graham

Baker

et al. 2009

In population‐based studies, hip displacement affects approximately one‐third of children with cerebral palsy (CP). Given the extreme range of clinical phenotypes in the CP spectrum, it is unsurprising that hip development varies from normality, to dislocation and degenerative arthritis. Numerous radiological indices are available to measure hip displacement in children with CP; however, there is no grading system for assessing hip status in broad categorical terms. This makes it difficult to audit the incidence of hip displacement, determine the relationship between hip displacement and CP subtypes, assess the outcome of intervention studies, and to communicate hip status between health care professionals. We developed a categorical, radiographic classification of hip morphology based on qualitative indices and measurement of the key continuous variable, the migration percentage of Reimers. One hundred and thirty‐four radiographs were reviewed of 52 female and 82 male adolescents with CP who were at, or close to, skeletal maturity (mean age 16y 1mo [SD 1y 4mo] range 14y to 19y 1mo). Twenty‐nine were classified at Gross Motor Function Classification System level I, 25 at level II, 27 at level III, 24 at level IV, and 29 at level V. A classification system was developed to encapsulate the full spectrum of hip morphology in CP, with and without intervention.

“…Sixteen patients (23 hips) had femoral neck resection below the lesser trochanter with muscle interposition (FHRT), as described by McCarthy; 32 11 patients (15 hips) had the McHale procedure. 33 Complications were higher for the FHRT group. Patients or caregivers were asked to evaluate their overall satisfaction with the surgery.…”

Section: Valgus Support Osteotomymentioning

confidence: 89%

“…More recently, Hogan et al 33 reported on their modified Haas valgus-subtrochanteric osteotomy in 31 hips in 24 patients. Although they had 15 complications, the majority of the patients were doing well at an average of 44 months after surgery.…”

Section: Valgus Support Osteotomymentioning

confidence: 99%

Surgical treatment for hip pain in the adult cerebral palsy patient

Root

2009

Hip subluxation or dislocation in the cerebral palsy population is an acquired condition that can result in pain and limitation of function. The incidence is reported to be from 18 to 59%. Awareness of the factors that cause the problem are essential in order to prevent this condition. Early treatment consists of appropriate muscle lengthening or releases, varus rotation hip osteotomies and in some cases pelvic osteotomies to provide acetabular coverage for the femoral head. For painful hip subluxation or dislocation with arthrosis in the adolescent or adult salvage procedures such as hip arthrodesis, valgus osteotomy, proximal femoral resection, or total hip arthroplasty have all been done to relieve pain. The author recounts his experience of the surgical management of the hip in the individual with cerebral palsy.