Management of Hip Deformities in Cerebral Palsy
University Orthopedic Specialist, Tucson, AZ 85718, USA.Orthopedic Clinics of North America (Impact Factor: 1.25). 10/2010; 41(4):549-59. DOI: 10.1016/j.ocl.2010.07.002
Hip abnormalities affect most children with cerebral palsy. Dedicated surveillance programs have been shown to be effective means of identifying hips at risk and preventing pathologic dislocation. Patients who are ambulatory and correlate with Gross Motor Function Classification Score I and II experience deformities that affect mobility and gait, but rarely dislocations. Marginal and nonambulatory patients have an increasing risk of dislocation. Once subluxation has been identified, early surgical intervention is indicated. Long-term postoperative follow-up is needed to monitor for recurrence. Individuals who recur or who do not respond to initial soft tissue releases benefit from bony surgery. Comprehensive reconstruction of the hip has become the predominant treatment approach when acetabular and proximal femoral dysplasia is present. The painful arthritic dislocated hip has numerous treatment options. Hip arthroplasty procedures show promising results and may supplant other salvage options in the future.
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ABSTRACT: Progressive hip displacement is the second most common deformity in children with cerebral palsy (CP). For many decades, the methods of monitoring hip health and development in children with CP varied widely between facilities. Recently, systematic population based studies have identified some of the factors and characteristics of children with CP who would most benefit from hip surveillance. Health services providing hip surveillance within Australia identified a need for clinical guidelines to assist in provision of comprehensive and best practice health care for children with CP across all patient demographics. Guidelines providing clear, evidence based information on specific timing for commencement, frequency, and discharge have not previously been published. This article analyses the supportive evidence for comprehensive hip surveillance, discusses the development of draft guidelines in Australia, and describes the process for achieving national consensus resulting in the Consensus Statement on Hip Surveillance for Children with Cerebral Palsy: Australian Standards of Care. These standards of care are being followed in clinical facilities across Australia and are endorsed by the Australasian Academy of Cerebral Palsy and Developmental Medicine (AusACPDM).
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ABSTRACT: Treatment with an unconventional double osteotomy of the pelvis in a 9-year-old girl with recurrent anterior hip subluxation after hip reconstruction in cerebral palsy is presented. Classical Pemberton or Salter osteotomy is effective for superolateral acetabular dysplasia, but corrections in the anterior or posterior direction are limited. In this case, double osteotomy of the pubic and iliac bone allowed better coverage in the anterior part of the acetabulum. The bone provided sufficient elasticity to achieve the desired correction without an ischial cut, therefore providing more stability of the pelvis.
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