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A balanced approach for stable hips in children with cerebral palsy: a combination of moderate VDRO and pelvic osteotomy.

Reidy K, Heidt C, Dierauer S, Huber H - J Child Orthop (2016)

Bottom Line: The mean pre-operative NSA angle of 152.3° was reduced to 132.6° post-operatively.Reimers' migration percentage (MP) was improved from 63.6 % pre-operatively to 2.7 % post-operatively and showed a mean of 9.7 % at the final review.This approach maintains good hip abduction and reduces soft-tissue surgery.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland. kerstin.reidy@kispi.uzh.ch.

ABSTRACT

Background: Hip reconstructive surgery in cerebral palsy (CP) patients necessitates either femoral varus derotational osteotomy (VDRO) or pelvic osteotomy, or both. The purpose of this study is to review the results of a moderate varisation [planned neck shaft angle (NSA) of 130°] in combination with pelvic osteotomy for a consecutive series of patients.

Methods: Patients with CP who had been treated at our institution for hip dysplasia, subluxation or dislocation with VDRO in combination with pelvic osteotomy between 2005 and 2010 were reviewed.

Results: Forty patients with a mean follow-up of 5.4 years were included. The mean age at the time of operation was 8.9 years. The majority were non-ambulant children [GMFCS I-III: n = 11 (27.5 %); GMFCS IV-V: n = 29 (72.5 %)]. In total, 57 hips were treated with both femoral and pelvic osteotomy. The mean pre-operative NSA angle of 152.3° was reduced to 132.6° post-operatively. Additional adductor tenotomy was performed in nine hips (16 %) at initial operation. Reimers' migration percentage (MP) was improved from 63.6 % pre-operatively to 2.7 % post-operatively and showed a mean of 9.7 % at the final review. The results were good in 96.5 % (n = 55) with centred, stable hips (MP <33 %), fair in one with a subluxated hip (MP 42 %) and poor in one requiring revision pelvic osteotomy for ventral instability.

Conclusions: This approach maintains good hip abduction and reduces soft-tissue surgery. Moderate varisation in VDRO in combination with pelvic osteotomy leads to good mid-term results with stable, pain-free hips, even in patients with severe spastic quadriplegia.

No MeSH data available.


Related in: MedlinePlus

Female, aged 7.2 years, GMFCS V. a Pre-operative: right hip MP 100 %, NSA 145°, left hip MP 100 %, NSA 145°. b Post-operative NSA: right hip 128°, left hip 132°. c Two years post-operative. d Five years post-operative: right hip MP 16 %, NSA 131°, left hip MP 21 %, NSA 137°
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Fig2: Female, aged 7.2 years, GMFCS V. a Pre-operative: right hip MP 100 %, NSA 145°, left hip MP 100 %, NSA 145°. b Post-operative NSA: right hip 128°, left hip 132°. c Two years post-operative. d Five years post-operative: right hip MP 16 %, NSA 131°, left hip MP 21 %, NSA 137°

Mentions: The mean measured post-operative NSA was 132.6° (range 115°–146°). At the latest follow-up, the mean NSA was 137.2° (range 116°–159°) (Fig. 2). Pre-operatively, we found in non-walkers a slightly higher NSA than in walkers (not significant). The post-operative NSA in non-walkers was significantly lower than in walkers (131.5° vs. 136.3°, p < 0.011). Interestingly, non-walkers showed less elevation of the NSA (131.5°–135.4°) compared to walkers (136.3°–143.8°) at final follow-up (Table 2). Reimers’ MP could be improved from a mean of 63.6 % pre-operatively to 2.7 % post-operatively. At the latest follow-up, the mean MP was 9.7 % (Table 2). We did not see any statistical difference between walkers and non-walkers regarding the MP.Fig. 2


A balanced approach for stable hips in children with cerebral palsy: a combination of moderate VDRO and pelvic osteotomy.

Reidy K, Heidt C, Dierauer S, Huber H - J Child Orthop (2016)

Female, aged 7.2 years, GMFCS V. a Pre-operative: right hip MP 100 %, NSA 145°, left hip MP 100 %, NSA 145°. b Post-operative NSA: right hip 128°, left hip 132°. c Two years post-operative. d Five years post-operative: right hip MP 16 %, NSA 131°, left hip MP 21 %, NSA 137°
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4940248&req=5

Fig2: Female, aged 7.2 years, GMFCS V. a Pre-operative: right hip MP 100 %, NSA 145°, left hip MP 100 %, NSA 145°. b Post-operative NSA: right hip 128°, left hip 132°. c Two years post-operative. d Five years post-operative: right hip MP 16 %, NSA 131°, left hip MP 21 %, NSA 137°
Mentions: The mean measured post-operative NSA was 132.6° (range 115°–146°). At the latest follow-up, the mean NSA was 137.2° (range 116°–159°) (Fig. 2). Pre-operatively, we found in non-walkers a slightly higher NSA than in walkers (not significant). The post-operative NSA in non-walkers was significantly lower than in walkers (131.5° vs. 136.3°, p < 0.011). Interestingly, non-walkers showed less elevation of the NSA (131.5°–135.4°) compared to walkers (136.3°–143.8°) at final follow-up (Table 2). Reimers’ MP could be improved from a mean of 63.6 % pre-operatively to 2.7 % post-operatively. At the latest follow-up, the mean MP was 9.7 % (Table 2). We did not see any statistical difference between walkers and non-walkers regarding the MP.Fig. 2

Bottom Line: The mean pre-operative NSA angle of 152.3° was reduced to 132.6° post-operatively.Reimers' migration percentage (MP) was improved from 63.6 % pre-operatively to 2.7 % post-operatively and showed a mean of 9.7 % at the final review.This approach maintains good hip abduction and reduces soft-tissue surgery.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland. kerstin.reidy@kispi.uzh.ch.

ABSTRACT

Background: Hip reconstructive surgery in cerebral palsy (CP) patients necessitates either femoral varus derotational osteotomy (VDRO) or pelvic osteotomy, or both. The purpose of this study is to review the results of a moderate varisation [planned neck shaft angle (NSA) of 130°] in combination with pelvic osteotomy for a consecutive series of patients.

Methods: Patients with CP who had been treated at our institution for hip dysplasia, subluxation or dislocation with VDRO in combination with pelvic osteotomy between 2005 and 2010 were reviewed.

Results: Forty patients with a mean follow-up of 5.4 years were included. The mean age at the time of operation was 8.9 years. The majority were non-ambulant children [GMFCS I-III: n = 11 (27.5 %); GMFCS IV-V: n = 29 (72.5 %)]. In total, 57 hips were treated with both femoral and pelvic osteotomy. The mean pre-operative NSA angle of 152.3° was reduced to 132.6° post-operatively. Additional adductor tenotomy was performed in nine hips (16 %) at initial operation. Reimers' migration percentage (MP) was improved from 63.6 % pre-operatively to 2.7 % post-operatively and showed a mean of 9.7 % at the final review. The results were good in 96.5 % (n = 55) with centred, stable hips (MP <33 %), fair in one with a subluxated hip (MP 42 %) and poor in one requiring revision pelvic osteotomy for ventral instability.

Conclusions: This approach maintains good hip abduction and reduces soft-tissue surgery. Moderate varisation in VDRO in combination with pelvic osteotomy leads to good mid-term results with stable, pain-free hips, even in patients with severe spastic quadriplegia.

No MeSH data available.


Related in: MedlinePlus