PURPOSE: Neurogenic hip dislocation is frequently observed in patients with cerebral palsy (CP). If the hip is not centred but not dislocated, the hip joint can be recentered with minor operative effort. Reconstructive procedures are indicated if the femoral head is subluxated or dislocated. There are no data as to when destruction of the femoral head requires a salvage procedure or whether hip reconstruction surgery is successful in restoring joint congruity in patients with CP. Our aim was to investigate femoral head plasticity after hip reconstruction surgery in a long-term outcome study. METHODS: We studied a large cohort of patients with CP and high hip dislocation (Tönnis grade IV) before surgery. Sixty-eight patients were assessed, of whom 23 presented with bilateral high hip dislocation, and 91 complex hip reconstructions were conducted. Standardised radiographic examination was performed before and directly after surgery and at the long-term follow-up examination. RESULTS: Pain was the most frequent reason for complex hip-joint reconstruction (49 patients, 72%). An impressive improvement in pain was demonstrated postoperatively. Forty-five hip joints presented aspheric incongruity postoperatively, which improved on average 7.7 years after surgery and 59 hip joints showed congruency. Only 15% of patients experienced pain at the time of final follow-up, and that was of low intensity. CONCLUSIONS: Early conservative treatment for hip dislocation is helpful, and operative reconstruction should also be scheduled early. Continued surveillance is necessary, and Reimers index is useful for monitoring the development of hip centering. In case of hip pain and femoral head deformity, our long-term study indicates that hip reconstruction surgery as a part of multilevel surgery improves pain and function in patients with CP and Tönnis IV hip dislocation, even if the hip joint is incongruent after operation. This incongruity improves over the long-term. If possible, a reconstruction procedure should be performed before the femoral head becomes deformed. High plasticity of the hip joint suggest that even if the femoral head is deformed, hip reconstruction can be recommended.
PURPOSE:Neurogenic hip dislocation is frequently observed in patients with cerebral palsy (CP). If the hip is not centred but not dislocated, the hip joint can be recentered with minor operative effort. Reconstructive procedures are indicated if the femoral head is subluxated or dislocated. There are no data as to when destruction of the femoral head requires a salvage procedure or whether hip reconstruction surgery is successful in restoring joint congruity in patients with CP. Our aim was to investigate femoral head plasticity after hip reconstruction surgery in a long-term outcome study. METHODS: We studied a large cohort of patients with CP and high hip dislocation (Tönnis grade IV) before surgery. Sixty-eight patients were assessed, of whom 23 presented with bilateral high hip dislocation, and 91 complex hip reconstructions were conducted. Standardised radiographic examination was performed before and directly after surgery and at the long-term follow-up examination. RESULTS:Pain was the most frequent reason for complex hip-joint reconstruction (49 patients, 72%). An impressive improvement in pain was demonstrated postoperatively. Forty-five hip joints presented aspheric incongruity postoperatively, which improved on average 7.7 years after surgery and 59 hip joints showed congruency. Only 15% of patients experienced pain at the time of final follow-up, and that was of low intensity. CONCLUSIONS: Early conservative treatment for hip dislocation is helpful, and operative reconstruction should also be scheduled early. Continued surveillance is necessary, and Reimers index is useful for monitoring the development of hip centering. In case of hip pain and femoral head deformity, our long-term study indicates that hip reconstruction surgery as a part of multilevel surgery improves pain and function in patients with CP and Tönnis IV hip dislocation, even if the hip joint is incongruent after operation. This incongruity improves over the long-term. If possible, a reconstruction procedure should be performed before the femoral head becomes deformed. High plasticity of the hip joint suggest that even if the femoral head is deformed, hip reconstruction can be recommended.
Authors: Benjamin J Shore; Xavier Yu; Sameer Desai; Paulo Selber; Rory Wolfe; H Kerr Graham Journal: J Bone Joint Surg Am Date: 2012-02-15 Impact factor: 5.284
Authors: Federico Canavese; Khaled Emara; Jonathan N Sembrano; Victor Bialik; Michael D Aiona; Michael D Sussman Journal: J Pediatr Orthop Date: 2010-06 Impact factor: 2.324
Authors: Eric J K Boldingh; Monique A M Jacobs-van der Bruggen; Cees F A Bos; Gustaaf J Lankhorst; Lex M Bouter Journal: J Pediatr Orthop B Date: 2005-03 Impact factor: 1.041
Authors: H Kerr Graham; Roslyn Boyd; John B Carlin; Fiona Dobson; Kevin Lowe; Gary Nattrass; Pam Thomason; Rory Wolfe; Dinah Reddihough Journal: J Bone Joint Surg Am Date: 2008-01 Impact factor: 5.284
Authors: Komalam Muthusamy; Heng-Yi Chu; Richard M Friesen; Pei-Chi Chou; Robert E Eilert; Franklin M Chang Journal: J Pediatr Orthop Date: 2008-12 Impact factor: 2.324
Authors: Frank Braatz; Daniel Staude; Matthias C Klotz; Sebastian I Wolf; Thomas Dreher; Stefan Lakemeier Journal: Int Orthop Date: 2015-10-10 Impact factor: 3.075
Authors: Lorenz Pisecky; Gerhard Großbötzl; Manuel Gahleitner; Christian Stadler; Stella Stevoska; Christina Haas; Tobias Gotterbarm; Matthias Christoph Michael Klotz Journal: Children (Basel) Date: 2022-02-18
Authors: Lorenz Pisecky; Gerhard Großbötzl; Stella Stevoska; Matthias Christoph Michael Klotz; Christina Haas; Tobias Gotterbarm; Matthias Luger; Manuel Gahleitner Journal: Children (Basel) Date: 2022-03-21