ANTERIOR HIP DISLOCATION IN CHILDREN WITH CEREBRAL-PALSY

This is a report of 27 hips with anterior dislocation in 17 children w ith cerebral palsy. Type I consists of patients with extension-externa l rotation and adduction contracture of the hip and extension contract ure of the knee; type 2 consists of patients with extension-external r otation and abduction contracture of the hip and flexion contracture o f the knee; and type 3 consists of patients without contractures. All children with types 1 and 2 were unable to sit and were forced into an almost full-time lying position. No child with type 3 pattern had sit ting troubles. Hip pain was present in 50% of patients. All children w ith type 1 pattern and half of children with types 2 and 3 developed a thoracolumbar kyphosis. Standard radiographic hip measurements were i nconsistent, and only three-dimensional computed tomography scans were useful In fully assessing the deformity. Indications for hip surgery were inability to sit or hip pain or both. Reconstruction was performe d by anterior superior acetabular reconstruction and varus-shortening femoral osteotomy or proximal femur resection as a salvage procedure. Although three of the 13 children required two procedures, 11 of 13 ch ildren who underwent 16 hip procedures had stable and painless hips at the time of follow-up.