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Journal of Pediatric Orthopaedics:
doi: 10.1097/BPO.0b013e3182924677
Cerebral Palsy

Outcomes After Salvage Procedures for the Painful Dislocated Hip in Cerebral Palsy

Wright, Patrick B. MD; Ruder, John BS; Birnbaum, Mark A. MD; Phillips, Jonathan H. MD; Herrera-Soto, Jose A. MD; Knapp, Dennis R. MD

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Abstract

Background: The painful dislocated hip in the setting of cerebral palsy is a challenging problem. Many surgical procedures have been reported to treat this condition with varying success rates. The purpose of this study is to retrospectively evaluate and compare the outcomes of 3 different surgical procedures performed at our institution for pain relief in patients with spastic quadriplegic cerebral palsy and painful dislocated hips.

Methods: A retrospective chart review of the surgical procedures performed by 5 surgeons for spastic, painful dislocated hips from 1997 to 2010 was performed. The procedures identified were (1) proximal femoral resection arthroplasty (PFRA); (2) subtrochanteric valgus osteotomy (SVO) with femoral head resection; and (3) proximal femur prosthetic interposition arthroplasty (PFIA) using a humeral prosthesis. Outcomes based on pain and range of motion were determined to be excellent, good, fair, or poor by predetermined criteria.

Results: Forty-four index surgeries and 14 revision surgeries in 33 patients with an average follow-up of 49 months met the inclusion criteria. Of the index surgeries, 12 hips were treated with a PFRA, 21 with a SVO, and 11 with a PFIA. An excellent or good result was noted in 67% of PFRAs, 67% of SVOs, and 73% of PFIAs. No statistical significance between these procedures was achieved. The 14 revisions were performed because of a poor result from previous surgery, demonstrating a 24% reoperation rate overall. No patients classified as having a fair result underwent revision surgery. All patients receiving revision surgery were eventually classified as having an excellent or good result.

Conclusions: Surgical treatment for the painful, dislocated hip in the setting of spastic quadriplegic cerebral palsy remains unsettled. There continue to be a large percentage of failures despite the variety of surgical techniques designed to treat this problem. These failures can be managed, however, and eventually resulted in a good outcome. We demonstrated a trend toward better outcomes with a PFIA, but further study should be conducted to prove statistical significance.

Level of Evidence: III.

© 2013 by Lippincott Williams & Wilkins

The Pediatric Orthopaedic Society of North America (POSNA)
is a group of healthcare professionals, primarily pediatric orthopaedic surgeons, dedicated to advancing musculoskeletal care of children and adolescents. JPO is our official member journal. 
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