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Combined Femoral and Pelvic Osteotomies Versus Femoral Osteotomy Alone in the Treatment of Hip Dysplasia in Children With Cerebral Palsy

Al-Ghadir, Muaz MD; Masquijo, Julio Javier MD; Guerra, Luis A. MD; Willis, Baxter MD

doi: 10.1097/BPO.0b013e3181b76968
Cerebral Palsy

Purpose Although evidence is increasing that the most effective treatment for the severely subluxated or dislocated hips is a one-stage comprehensive approach there are few studies that compare the results with the traditional approach (varus derotational osteotomy, VDRO). The purpose of this study is to evaluate the clinical and radiologic outcome after one-stage reconstruction versus VDRO alone.

Methods We retrospectively analyzed 52 hips in 39 consecutive patients with spastic cerebral palsy treated from January 1997 to January 2007. Group A (36 hips) was treated with a VDRO and San Diego osteotomy and group B (16 hips) with VDRO alone. Mean age was 8.1±3.6 years. Mean follow-up was 4.4 years. Evaluation was performed according to clinical criteria (hip range of motion, pain, and sitting comfort) and radiographic parameters [center-edge angle, acetabular index, neckshaft angle, and Reimer's Index (MI)].

Results There were no delayed unions, avascular necrosis of the femoral head, or postoperative infections in either group. There was significant decrease in pain and improvement of the center-edge angle and acetabular index in the combined approach. Of the patients who had VDRO alone 25% needed revision procedures and none of the combined group needed other procedures.

Conclusions The clinical and radiologic results obtained by the one-stage procedure were far better than doing VDRO alone justifying a more extensive approach. Consideration should be given to performing the combined procedure in cerebral palsy patients with hip subluxation or dislocation.

Department of Pediatric Orthopaedics, Children's Hospital of Eastern Ontario, University of Ottawa, Canada

Reprints: Baxter Willis, MD, Department of Pediatric Orthopaedics, Children's Hospital of Eastern Ontario, University of Ottawa, Canada, 401 Smyth Road. Ottawa, Ontario, Canada K1H 8L1. E-mail: bwillis@cheo.on.ca.

Received for Publication February 26, 2009

accepted June 30, 2009

No funding was received for this work from any organizations.

© 2009 Lippincott Williams & Wilkins, Inc.