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Proximal femoral excision with interposition myoplasty for cerebral palsy patients with painful chronic hip dislocation.

Patel NK, Sabharwal S, Gooding CR, Hashemi-Nejad A, Eastwood DM - J Child Orthop (2015)

Bottom Line: One procedure required revision at 12 months.Mean pain score improved from 7.8 (5-10) pre-operatively to 2.8 (1-5) post-operatively (p < 0.001).Sitting tolerance improved in all patients and in 75 % (15) perineal care was easier.

View Article: PubMed Central - PubMed

Affiliation: The Catterall Unit, The Royal National Orthopaedic Hospital, Stanmore, Middlesex, HA7 4LP, UK, niravpatel@doctors.org.uk.

ABSTRACT

Purpose: Proximal femoral excision is a salvage procedure for painful chronic hip dislocation in cerebral palsy (CP) patients. The primary objective of this article is to describe our experience of an amplified interposition myoplasty, with appropriate peri-operative pain and tone management strategies, in a cohort of non-ambulatory CP patients with painful chronic hip dislocation. Our secondary objective is to present the clinical outcomes of these patients.

Methods: We describe our experience in 20 CP patients (25 procedures) at mean 54-month (range 27-169) follow-up with a surgical technique that includes an augmented interposition myoplasty and tone management. The indications for surgery were pain (21 hips), poor sitting tolerance (11) and difficulty with perineal care (8).

Results: The mean age was 22 years (range 10-40) with 11 patients Gross Motor Function Classification Scale (GMFCS) IV and 9 patients GMFCS V. Mean length of stay was 13 days (3-35). One procedure required revision at 12 months. Mean pain score improved from 7.8 (5-10) pre-operatively to 2.8 (1-5) post-operatively (p < 0.001). Sitting tolerance improved in all patients and in 75 % (15) perineal care was easier.

Conclusions: Our interposition myoplasty technique with individualised pain/tone management has good outcomes in this cohort of patients with multiple co-morbidities.

No MeSH data available.


Related in: MedlinePlus

Proximal femur exposed and excised below the level of the lesser trochanter (black arrow)
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Related In: Results  -  Collection


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Fig1: Proximal femur exposed and excised below the level of the lesser trochanter (black arrow)

Mentions: Under general anaesthesia with local anesthetic and adrenaline skin infiltration, a posterior approach to the hip is followed (see Online Resource). After release of the glutei and vasti from the femur, a capsulotomy and iliopsoas release are performed. The proximal femur is resected 3–4 cm below the lesser trochanter (Fig. 1). Our interposition myoplasty is a modification of the technique described by McCarthy et al. [18]. The acetabulum is covered with a double-breasted capsular repair, and a sling is formed by tenodesing iliopsoas to the glutei, which is sutured to the capsule (Fig. 2), followed by the short external rotators. Drill holes in the proximal femur for transosseus sutures are used to create a muscular envelope using the vasti and medial soft tissues (Fig. 3), resulting in a significant interposition myoplasty (Fig. 4).Fig. 1


Proximal femoral excision with interposition myoplasty for cerebral palsy patients with painful chronic hip dislocation.

Patel NK, Sabharwal S, Gooding CR, Hashemi-Nejad A, Eastwood DM - J Child Orthop (2015)

Proximal femur exposed and excised below the level of the lesser trochanter (black arrow)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4549349&req=5

Fig1: Proximal femur exposed and excised below the level of the lesser trochanter (black arrow)
Mentions: Under general anaesthesia with local anesthetic and adrenaline skin infiltration, a posterior approach to the hip is followed (see Online Resource). After release of the glutei and vasti from the femur, a capsulotomy and iliopsoas release are performed. The proximal femur is resected 3–4 cm below the lesser trochanter (Fig. 1). Our interposition myoplasty is a modification of the technique described by McCarthy et al. [18]. The acetabulum is covered with a double-breasted capsular repair, and a sling is formed by tenodesing iliopsoas to the glutei, which is sutured to the capsule (Fig. 2), followed by the short external rotators. Drill holes in the proximal femur for transosseus sutures are used to create a muscular envelope using the vasti and medial soft tissues (Fig. 3), resulting in a significant interposition myoplasty (Fig. 4).Fig. 1

Bottom Line: One procedure required revision at 12 months.Mean pain score improved from 7.8 (5-10) pre-operatively to 2.8 (1-5) post-operatively (p < 0.001).Sitting tolerance improved in all patients and in 75 % (15) perineal care was easier.

View Article: PubMed Central - PubMed

Affiliation: The Catterall Unit, The Royal National Orthopaedic Hospital, Stanmore, Middlesex, HA7 4LP, UK, niravpatel@doctors.org.uk.

ABSTRACT

Purpose: Proximal femoral excision is a salvage procedure for painful chronic hip dislocation in cerebral palsy (CP) patients. The primary objective of this article is to describe our experience of an amplified interposition myoplasty, with appropriate peri-operative pain and tone management strategies, in a cohort of non-ambulatory CP patients with painful chronic hip dislocation. Our secondary objective is to present the clinical outcomes of these patients.

Methods: We describe our experience in 20 CP patients (25 procedures) at mean 54-month (range 27-169) follow-up with a surgical technique that includes an augmented interposition myoplasty and tone management. The indications for surgery were pain (21 hips), poor sitting tolerance (11) and difficulty with perineal care (8).

Results: The mean age was 22 years (range 10-40) with 11 patients Gross Motor Function Classification Scale (GMFCS) IV and 9 patients GMFCS V. Mean length of stay was 13 days (3-35). One procedure required revision at 12 months. Mean pain score improved from 7.8 (5-10) pre-operatively to 2.8 (1-5) post-operatively (p < 0.001). Sitting tolerance improved in all patients and in 75 % (15) perineal care was easier.

Conclusions: Our interposition myoplasty technique with individualised pain/tone management has good outcomes in this cohort of patients with multiple co-morbidities.

No MeSH data available.


Related in: MedlinePlus