Surgical treatment of subluxation and dislocation of the hips in cerebral palsy patients

Background and Purpose: Progressive subluxation and dislocation of the hip are major complications in patients with cerebral palsy (CP),causing functi onal deterioration and difficulties in personal hygiene. Treatment of these problems is difficult and complicated. The purpose of this study was to de scribe the surgical results and longterm follow-up in a group of CP patient s. Methods: Twenty-three CP patients with subluxated (15 hips) or dislocated h ips (12 hips) underwent corrective surgery between 1985 and 1993. This incl uded 11 quadriplegic, eight diplegic, and four hemiplegic patients. Before surgery, four patients were bed-ridden, eight were sitters, six were house- ambulators, and five were community-ambulators. The average age at surgery was 8 years and 5 months. The surgical procedures consisted of femoral varu s derotational osteotomy in 21 patients (25 hips), selected soft tissue rel ease in 18 patients (22 hips), and pelvic osteotomy in 18 patients (20 hips ). The center-edge angle, acetabular index, and neck-shaft angle were used as parameters to evaluate preoperative and postoperative radiographic chang es. Results: After all average follow-up of 4.8 years, 19 patients (22 hips) ha d gained hip stability, and also had improved functional status. The four b ed-ridden patients all became sitters; six of the eight sitters became hous e-ambulators and one became a community-ambulator; all six house-ambulators became community-ambulators, and the five community-ambulators had functio nal improvement. Complications included nonunion at the femoral osteotomy s ite in one hip, redislocation in two hips, and resubluxation in one hip. Conclusions: We conclude that subluxated or dislocated hips in patients wit h CP can be effectively treated with aggressive correction, which may inclu de soft tissue release, femoral derotational osteotomy, and pelvic osteotom y for improvement of hip range of motion and functional status.