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Femoral Head Resection for Painful Hip Subluxation in Cerebral Palsy: Is Valgus Osteotomy in Conjunction With Femoral Head Resection Preferable to Proximal Femoral Head Resection and Traction?

Leet, Arabella I. MD*‡; Chhor, Kimberlly BA; Launay, Franck MD§; Kier-York, Jane RN*; Sponseller, Paul D. MD*

Neuromuscular: Original Article
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Patients with severe cerebral palsy who underwent either a femoral head resection with traction or a McHale procedure (femoral head resection and valgus osteotomy) were studied retrospectively and then contacted by telephone to assess whether removing the femoral head or proximal femur as a salvage procedure improved sitting tolerance, relieved pain, or improved hygiene. Twenty-seven patients (36 involved hips) were available for a retrospective chart and x-ray review, and over half (56%) of these patients or caretakers were able to complete a telephone questionnaire. Of the study cohort, 16 patients underwent femoral head resection with traction and 11 patients had a McHale procedure. The average age at surgery was 19 years and average follow-up was 3.4 years. For those in the McHale group, the length of stay in the hospital was shorter, the postoperative superior migration of the femoral head was less pronounced, and the surgical and medical complications were lower. The telephone survey showed that both groups had increased sitting tolerance and decreased pain, and both showed overall satisfaction with the surgical outcome.

From *Department of Orthopedics, Johns Hopkins University, Baltimore, Maryland; †Johns Hopkins University, School of Medicine, Baltimore, Maryland; ‡Kennedy Krieger Institute, Baltimore, Maryland; and §Hospital Timone, Marseille, France.

Study conducted at Johns Hopkins Hospital and the Kennedy Kreiger Institute, Baltimore, Maryland.

None of the authors received financial support for this study.

Reprints: Dr. Arabella I. Leet, Department of Orthopedic Surgery, Johns Hopkins University, 601 North Caroline Street, Room 5255, Baltimore, MD 21287-0882 (e-mail: aleet1@jhmi.edu).

© 2005 Lippincott Williams & Wilkins, Inc.