ORTHOPAEDIC DEPARTMENT
THE ALFRED I. DUPONT INSTITUTE
WILMINGTON, DELAWARE
Hip dislocation in children with spasticity secondary to cerebral palsy is common with the incidence being directly related to the severity of the spasicity. Non-ambulatory children with quadreplegic pattern involvement have the highest incidence. In approximately 50 percent of these individuals the dislocation leads to clinically significant pain if the dislocation is left untreated. In addition to pain the dislocated hip may cause difficulties with the individual's sitting ability and perineal hygiene; and it may contribute to the formation of pelvic obliquity, scoliosis, and skin breakdown. ) The direct cause of the dislocation is the spastic muscles which cause abnormal forces in the hip joint. In combination with growth, these abnormal forces cause significant deformities in the pelvic girdle and hip joint. These deformities include fixed muscle contractures, decreased hip joint range of motion, coxa valga, coxa anteverta, posterior-lateral and superior migration of the of the femoral head from the acetabulum, and oseous deformity of the posterior lateral aspect of the acetabulum. Preventing dislocation by early muscle release surgery is preferred and should be done bilaterally in an attempt to maintain balnace. Muscle release surgery is effective in children under age eight and and when the subluxation is not too severe. For the older patient and when the subluxation is severe or dislocation is present the hip must have correction of the secondary deformities with varus femoral osteotomy. Pelvic osteotomy of several different types has been recommended to address the acetabular deformity either seprately or in combination with varus osteotomy. My perferred method for children with cerebral palsy who had posterior-lateral hip subluxation or dislocation is a surgical reconstruction using a combination of muscle releases, varus osteotomy and pelvic osteotomy reconstructive procedure.
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