Short-term results of musculotendinous release for paralytic hip subluxation in children with spastic cerebral palsy.

INTRODUCTION

Children with paralytic hip subluxation secondary to spastic cerebral palsy were treated with a standard protocol that depended on early detection of the subluxation using clinical examination detecting limited range of hip abduction of <or= 30 degrees and anteroposterior pelvis radiographs detecting subluxation >or= 33% migration as indications.

PATIENTS AND

METHODS

Patients underwent open adductor longus, proximal gracilis and proximal rectus femoris myotomy, and iliopsoas lengthening with immediate postoperative immobilisation in abduction bar for 3 weeks followed by physiotherapy. The protocol was applied to 50 children with a mean age of 3.6 years with 100 hips surgically corrected. Of these hips initially, 52% were mildly subluxated with <or= 33% migration, 42% were moderately subluxated with > 33-66% migration, and 6% were severely subluxated with > 66% migration.

RESULTS

At a final postoperative follow-up of at least 24 months, 22% of these hips were classified as excellent with full containment and no migration, 54% were good with < 20% migration, and 24% were fair with 20-25% migration. No poor result with > 25% migration was obtained. No child developed an abduction contracture or wide-based gait that required treatment.

CONCLUSIONS

Early detection and application of this treatment algorithm for children with spastic hip disease should have satisfactory outcomes. Longer follow-up will be required to determine how many children will need bony reconstruction to maintain stable containment of hips at maturity.