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Bilateral hip surgery in severe cerebral palsy

A PRELIMINARY REVIEW

Department of Orthopaedics and Trauma, Southmead Hospital, Westburyon-Trym, Bristol BS10 5NB, UK.

J. Pyman, MCSP, Superintendent Physiotherapist; M. F. Gargan, FRCS, Consultant Orthopaedic Surgeon; P. J. Witherow, FRCS, Consultant Orthopaedic Surgeon; and N. M. A. Portinaro, MD, MSc, Consultant Orthopaedic Surgeon

The Bristol Royal Hospital for Sick Children, St Michael’s Hill, Bristol BS2 8BJ, UK.

Correspondence should be sent to Miss K. L. Owers.

When cerebral palsy involves the entire body pelvic asymmetry indicates that both hips are ‘at risk’. We carried out a six-year retrospective clinical, radiological and functional study of 30 children (60 hips) with severe cerebral palsy involving the entire body to evaluate whether bilateral simultaneous combined soft-tissue and bony surgery of the hip could affect the range of movement, achieve hip symmetry as judged by the windsweep index, improve the radiological indices of hip containment, relieve pain, and improve handling and function.

The early results at a median follow-up of three years showed improvements in abduction and adduction of the hips in flexion, fixed flexion contracture, radiological containment of the hip using both Reimer’s migration percentage and the centre-edge angle of Wiberg, and in relief of pain. Ease of patient handling improved and the satisfaction of the carer with the results was high. There was no difference in outcome between the dystonic and hypertonic groups.

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				M. J. Barakat, T. While, J. Pyman, M. Gargan, and F. Monsell Bilateral hip reconstruction in severe whole-body cerebral palsy: TEN-YEAR FOLLOW-UP RESULTS J Bone Joint Surg Br, October 1, 2007; 89-B(10): 1363 - 1368. [Abstract] [Full Text] [PDF]