PSOAS RELEASE AT THE PELVIC BRIM IN AMBULATORY PATIENTS WITH CEREBRAL-PALSY - OPERATIVE TECHNIQUE AND FUNCTIONAL OUTCOME

Seventeen patients with cerebral palsy (29 hips) underwent psoas reces sion at the pelvic brim. The operative technique was a direct anterior approach, lateral to the femoral sheath. Then were no infections or n erve or arterial injuries. After surgery, clinical examination reveale d that fixed hip-flexion contractures decreased significantly in all p atients. All of the subjects retained the ability to flex the hip agai nst gravity and against manual resistance. All of the subjects underwe nt pre-and postoperative gait analysis. Stance-phase dynamic minimum h ip flexion decreased significantly. Dynamic pelvic tilt improved to a statistically significant level for the younger children but did not f or the group as a whole. There was less improvement with increasing ag e. Step length was significantly increased and cadence significantly d ecreased in all patients. We conclude that psoas recession at the pelv ic brim, by using the anterior approach, lateral to the femoral sheath , is a safe, reliable, and effective procedure for children with cereb ral palsy who have excessive anterior pelvic tilt and excessive dynami c hip flexion or hip-flexion contracture.