Open adductor tenotomy in the prevention of hip subluxation in cerebral palsy (original) (raw)
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International Orthopaedics, 2009
This article summarises a comparative retrospective study (1983)(1984)(1985)(1986)(1987)(1988)(1989)(1990)(1991)(1992)(1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001) of 42 consecutive spastic-diplegic ambulatory patients (aged 2-10 years) by examining the radiographic and clinical results of two soft-tissue procedures for paralytic hip subluxation (PSH). Group A comprised 20 patients (26 PSHs) who were treated by iliopsoas tenotomy, and group B comprised 22 patients (31 PSHs) who were treated by rectus femoris and iliopsoas tenotomy with iliac crest resection (sartorius release). All patients had bilateral adductor tenotomies. At 8.8 years mean follow-up, group A migration percentages (MP) improved from 39.8% to 24.7% with 92.3% good/average results. At a mean follow-up period of 8.3 years, group B improved from 58.0% to 25.9% with 96.8% good/average results. Long-term hip reduction was achieved in 84.6% of group A and 80.6% of group B hips. Relative MP correction was superior in group B. No patient had MP progression in either the PSH or non-PSH hip. Walking ability improved in 55% of group A and 86% of group B patients (Functional Mobility Scale). In conclusion, we recommend release of all the principle hip flexors: rectus femoris, sartorius, and iliopsoas, coupled with adductor tenotomies, in this patient group.
Acta Orthopaedica, 2016
Background and purpose-Studies have indicated that one-third of children with cerebral palsy (CP) develop dislocation of the hip that needs surgical intervention. When hip dislocation occurs during childhood surgical treatment consists of tenotomies, femoral varus derotation osteotomy (VDRO), and acetabuloplasty. Relapse is observed in one-fi fth of cases during adolescence. In this prospective cohort study, we performed a descriptive evaluation of translation and rotation across VDROs in children with neuromuscular disorders and syndromes by radiostereometric analysis (RSA). We assessed "RSA stability" and migration across the VDROs. Patients and methods-Children with a neuromuscular disorder were set up for skeletal corrective surgery of the hip. RSA follow-ups were performed postoperatively, at 5 weeks, and 3, 6, and 12 months after surgery. Results-27 femoral VDROs were included; 2 patients were excluded during the study period. RSA data showed stability across the VDRO in the majority of cases within the fi rst 5 weeks. At the 1-year follow-up, the mean translations (SD) of the femoral shaft distal to the VDRO were 0.51 (1.12) mm medial, 0.69 (1.61) mm superior, and 0.21 (1.28) mm posterior. The mean rotations were 0.39° (2.90) anterior tilt, 0.02° (3.07) internal rotation, and 2.17° (2.29) varus angulation. Interpretation-The migration stagnates within the fi rst 5 weeks, indicating stability across the VDRO in most patients. ■ Cerebral palsy (CP) is a multidimensional neurological disease that begins before birth or in early childhood and persists throughout life (Minciu 2012). The incidence of CP in Denmark is 2 in 1,000 live births and the incidence has been stable since the 1990s (Ravn et al. 2010). Common symptoms in the
Effects of Increased Femoral Anterversion on Gait in Children with Cerebral Palsy
S Su um mm ma ar ry y O Ob bj je ec ct ti iv ve e: : The aim of this study is to identify the gait deviations due to increased femoral anteversion and to distinguish these deviations from those which are commonly seen in children with spastic diplegic cerebral palsy (SD). M Ma at te er ri ia al ls s a an nd d M Me et th ho od ds s: : The gait parameters of six neurologically intact children with increased femoral anteversion (NIFA), nine spastic diplegic children with increased femoral anteversion (CPIFA), and fifteen neurologically intact typically developing children (TD) were compared. 3D Motion Analysis System was used to analyze the sagittal plane pelvis, hip, knee, and ankle kinetics and kinematics, as well as the temporospatial parameters. R Re es su ul lt ts s: : Increased dorsiflexion and knee flexion at initial contact, increased mean pelvic anterior tilt during stance, decreased peak plantar flexion moment in terminal stance, increased double support time and decreased mean velocity which are the pure effect of SD, were significantly different in CPIFA group compared to NIFA and TD groups. A strong similarity existed between CPIFA and NIFA groups regarding the increased peak knee extension moment. C Co on nc cl lu us si io on n: : This study supported the hypothesis of "existence of relation between IFA and crouch posture". The orthopedic surgeons may consider the priority of planning femoral de-rotational osteotomy in surgical treatment schedule for children with CP. Turk J Phys Med Rehab 2009;55:135-40. K Ke ey y W Wo or rd ds s: : Femoral anteversion, cerebral palsy, gait analysis, gait parameters Ö Öz ze et t A Am ma aç ç: : Bu çal›flmada, femoral anteversiyon art›fl›n›n neden oldu¤u yürüme anomalilerini belirlemek ve bu anomalileri spastik diparezik tip serebral palsili (SD) çocuklarda gözlenen yürüme deviyasyonlar›ndan ay›rmak amaçlanm›flt›r. G Ge er re eç ç v ve e Y Yö ön nt te em m: : Alt› femoral anteversiyonu artm›fl nörolojik aç›dan normal olgunun (NFAA), dokuz fermoral anteversiyonu artm›fl SD'li olgunun (SDFAA) ve onbefl femoral anteversiyonu olmayan ve nörolojik aç›dan normal olgunun (NO) yürüme parametreleri karfl›laflt›r›lm›flt›r. Üç boyutlu hareket analiz sistemi ile sagital plan pelvis, kalça ve diz kinematik, kinetik ve zaman-mesafe parametreleri analiz edilmifltir. B Bu ul lg gu ul la ar r: : ‹lk temas faz›ndaki diz fleksiyon ve ayak dorsifleksiyon art›fl›-n›n, basma faz›ndaki ortalama pelvik anterior tilt art›fl›n›n, basma faz› sonundaki plantar fleksiyon momentindeki azalman›n, çift destek periyodundaki art›fl›n ve ortalama yürüme h›z›ndaki azalman›n SDFAA grubunda, NFAA ve NO grubuna göre istatistiksel olarak anlaml› derecede farkl› oldu¤u belirlenmifltir ki bu parametreler saf spastik diparezi etkisidir. DFAA grubundaki maksimum diz ekstansiyon momentindeki art›fl NFAA grubuyla kuvvetli derecede benzerdir ki bu durum saf femoral anteversiyon etkisini göstermektedir. S So on nu uç ç: : Bu sonuçlar femoral anteversiyon art›fl› ile çömelme postürü aras›ndaki iliflki varl›¤›n› savunan hipotezi desteklemektedir. Ortopedik cerrahinin, spastik diparezik serebral palsili hastalarda öncelikle artm›fl femoral anteversiyonu düzeltmeyi planlamas›, anormal yürüme parametrelerinin normale yaklaflmas›nda faydal› olabilir. Türk Fiz T›p Rehab Derg 2009;55:135-40. A An na ah ht ta ar r K Ke el li im me el le er r: : Femoral anteversion, serebral palsi, yürüme analizi, yürüme parametreleri
Characteristics of children with hip displacement in cerebral palsy
BMC Musculoskeletal Disorders, 2007
Background: Hip dislocation in children with cerebral palsy (CP) is a common and severe problem. The dislocation can be avoided, by screening and preventive treatment of children with hips at risk. The aim of this study was to analyse the characteristics of children with CP who develop hip displacement, in order to optimise a hip surveillance programme.
Determinants of Hip Displacement in Children With Cerebral Palsy
Clinical orthopaedics and related research, 2015
Coxa valga and femoral anteversion often are seen in patients with spastic hip displacement and osteotomy is recommended. However, the relationship between femoral deformities and hip displacement has not been clearly defined and other factors, such as joint motion and posture, should be considered before recommending treatment. For children with cerebral palsy with Gross Motor Function Classification System Level IV or V, we questioned (1) whether hip abduction range correlates with hip displacement, (2) what the relationships are between proximal femoral deformities and hip displacement, and (3) whether the patient with a windblown posture has greater degrees of femoral anteversion? We retrospectively studied 31 consecutive children with cerebral palsy with Level IV or V gross motor function who underwent three-dimensional CT for preoperative assessment of hip displacement between January 2010 and December 2013. Among the children, 23 had a windblown posture and eight had symmetri...