Subtrochanteric Valgus Osteotomy for Chronically Dislocated, Painful Spastic Hips

Hogan, Kathleen A.; Blake, Matthew H.; Gross, Richard H.

doi:10.2106/jbjs.g.00227

Cited by 8 publications

(10 citation statements)

References 6 publications

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“…It is therefore best avoided in GMFCS level IV and V patients. Valgus subtrochanteric osteotomy [ 26 ] may be more successful, although abutment of the proximal femur into the acetabulum and metalwork-associated problems are common [ 13 , 17 ]. Arthrodesis improves pain and lower limb position with good outcomes [ 2 , 16 ] but requires unilateral involvement, an ability to ambulate and no spine pathology [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

Proximal femoral excision with interposition myoplasty for cerebral palsy patients with painful chronic hip dislocation

Patel

Sabharwal

Gooding

et al. 2015

Journal of Children's Orthopaedics

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PurposeProximal femoral excision is a salvage procedure for painful chronic hip dislocation in cerebral palsy (CP) patients. The primary objective of this article is to describe our experience of an amplified interposition myoplasty, with appropriate peri-operative pain and tone management strategies, in a cohort of non-ambulatory CP patients with painful chronic hip dislocation. Our secondary objective is to present the clinical outcomes of these patients.MethodsWe describe our experience in 20 CP patients (25 procedures) at mean 54-month (range 27–169) follow-up with a surgical technique that includes an augmented interposition myoplasty and tone management. The indications for surgery were pain (21 hips), poor sitting tolerance (11) and difficulty with perineal care (8).ResultsThe mean age was 22 years (range 10–40) with 11 patients Gross Motor Function Classification Scale (GMFCS) IV and 9 patients GMFCS V. Mean length of stay was 13 days (3–35). One procedure required revision at 12 months. Mean pain score improved from 7.8 (5–10) pre-operatively to 2.8 (1–5) post-operatively (p < 0.001). Sitting tolerance improved in all patients and in 75 % (15) perineal care was easier.ConclusionsOur interposition myoplasty technique with individualised pain/tone management has good outcomes in this cohort of patients with multiple co-morbidities.Electronic supplementary materialThe online version of this article (doi:10.1007/s11832-015-0662-z) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Proximal femoral excision with interposition myoplasty for cerebral palsy patients with painful chronic hip dislocation

Patel

Sabharwal

Gooding

et al. 2015

Journal of Children's Orthopaedics

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“…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: Methodsmentioning

confidence: 99%

A classification system for hip disease in cerebral palsy

Robin

Graham

Baker

et al. 2009

Develop Med Child Neuro

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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.

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“…Studies that distinguished pain relief [4][5][6][7][8][9][10][11][12][13][14][15][16][17][20][21][22][24][25][26]28,30 and complication types and rates [4][5][6][7][8][9][10][11][12][13][14][15][16][17][19][20][21][22][24][25][26]28,30 among confirmed nonambulators were included in the analysis. Pain relief rates for femoral head resection (FHR), VO, total hip arthroplasty (THA), shoulder prosthetic interposition (SPI), and arthrodesis were 90.4%, 88.4%, 93.8%, 90.9%, and 56.3%, respectively.…”

Section: Nonambulatory Patientsmentioning

confidence: 99%