Soft tissue, varus derotation femoral and pelvic surgery in cerebral palsy children: A mid-term outcome study

BACKGROUND: Cerebral palsy (CP) patients have an increased risk of hip subluxation and dislocation. Management often involves surgical reduction, soft tissue release and stabilization with proximal femoral varus derotation osteotomy (VDO) combined to a pelvic osteotomy, if acetabular dysplasia is present. The purpose of this retrospective study was to report a mid-term follow-up on surgical management of the subluxated and/or dislocated hips in CP children. METHODS: From January 2007 to December 2015, 66 CP children (74 hips) were treated by soft tissue release, VDO and periacetabular osteotomy. Mean age at surgery was 10.41±2.02 (range:7.5-13.6 years). Clinical and radiographic outcomes and complications were recorded. Results were analyzed using a paired Student’s t-test to assess the pre and postoperative differences of all radiographic parameters. RESULTS: Mean follow-up time 37.32±2.64 months (range:34-41 months). Statistically significant improvement of preoperative values of Reimer’s migration index, Acetabular Index and Neck Shaft Angle was observed at the latest followup (from 66.11% to 3.95%, 45.31° to 27.15° and 161.57° to 122.55° respectively). Blood transfusion was necessary in 4 patients and wound dehiscence/infection in 3; No AVN, osteolysis, premature closure of triradiate cartilage, bony fracture or loosening were recorded. CONCLUSIONS: VDO combined to periacetabular osteotomy and soft-tissue release is an effective treatment in subluxated and/or dislocated hips in CP children.