Resection arthroplasty of the hip for patients with cerebral palsy: An outcome study

Thirteen patients (18 hips) with cerebral palsy and painful hip subluxation or dislocation underwent proximal femoral resection-interposition arthropl asty (PFRIA) as a salvage procedure for intractable pain or seating difficu lty. Eleven patients (14 hips) had a prior failed soft-tissue or bony recon struction. The average age at surgery was 26.6 years (range, 10.7-45.5 year s), and average follow-up was 7.4 years (range, 2.2-20.8 years). All patien ts/caregivers noted significant improvement in subjective assessment of pai n after the surgery. Upright sitting tolerance improved from an average pre operative value of 3.2-8.9 h postoperatively (p < 0.01). Four patients who were unable even to sit in a customized wheelchair before the operation cou ld be easily seated in a custom chair after surgery. Hip range of motion in cluding flexion, extension, and abduction was significantly improved postop eratively (p < 0.05). Single-dose radiation therapy was used postoperativel y for five hips and resulted in a significantly lower grade of heterotopic ossification at final follow-up (p < 0.005). Skeletal traction in the posto perative period did not prevent proximal migration of the femur compared wi th skin traction. Maximal pain relief was achieved at an average of 5.6 mon ths postoperatively (range, 0.03-14 months). Complications included transie nt postoperative decubitus ulceration (four patients), pneumonia (two patie nts), and symptomatic heterotopic bone (two patients). The significant impr ovements in pain management, sitting tolerance, and range of motion suggest that PFRIA is a reasonable salvage procedure for the painful, dislocated h ip in cerebral palsy. Resolution of pain may not be immediate, as was noted in this series.