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Psoas Release at the Pelvic Brim in Ambulatory Patients with Cerebral Palsy: Operative Technique and Functional Outcome

Sutherland, D. H. M.D.*†; Zilberfarb, J. L. M.D.; Kaufman, K. R. Ph.D.*†; Wyatt, M. P. P.T., M.A.*; Chambers, H. G. M.D.*†

Neuromuscular

Summary: Seventeen patients with cerebral palsy (29 hips) underwent psoas recession at the pelvic brim. The operative technique was a direct anterior approach, lateral to the femoral sheath. There were no infections or nerve or arterial injuries. After surgery, clinical examination revealed that fixed hip-flexion contractures decreased significantly in all patients. All of the subjects retained the ability to flex the hip against gravity and against manual resistance. All of the subjects underwent pre- and postoperative gait analysis. Stance-phase dynamic minimum hip flexion decreased significantly. Dynamic pelvic tilt improved to a statistically significant level for the younger children but did not for the group as a whole. There was less improvement with increasing age. Step length was significantly increased and cadence significantly decreased in all patients. We conclude that psoas recession at the pelvic brim, by using the anterior approach, lateral to the femoral sheath, is a safe, reliable, and effective procedure for children with cerebral palsy who have excessive anterior pelvic tilt and excessive dynamic hip flexion or hip-flexion contracture.

From *Children's Hospital, University of California, San Diego, and Naval Regional Medical Center, San Diego, California, U.S.A.

Study conducted at the Children's Hospital, San Diego, California, U.S.A.

Address correspondence and reprint requests to Dr. D. H. Sutherland, Children's Hospital, 3020 Children's Way, MC 5054, San Diego, CA 92123, U.S.A.

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