Proximal femoral resection-interposition arthroplasty: salvage hip surgery for the severely disabled child with cerebral palsy.

The treatment of spastic hip dislocation by proximal femoral resection-interposition arthroplasty (PFRIA) has not been popular because of previous unfavorable experience with Girdlestone-type resections. Since 1979, four severely disabled patients with cerebral palsy having five painful, spastic hip dislocations have undergone PFRIA at the Children's Hospital of Eastern Ontario (Ottawa, Ontario, Canada) by the technique described by Castle and Schneider. The preliminary follow-up shows no significant loss of motion, no bony ankylosis or impingement, no myositis ossificans, and no recurrence of pain. A comfortable sitting status was achieved within 3-6 weeks postoperatively. For a carefully selected group of severely disabled, spastic, nonambulatory patients with painful hip dislocation, we recommend this procedure over more complicated reconstructive procedures or arthrodesis.