Two-stage surgery in the treatment of spastic hip dislocation--comparison between early and late results of open reduction and derotation-varus femoral osteotomy combined with Dega pelvic osteotomy preceded by soft tissue release.

BACKGROUND

Authors present and compare early and late results of treatment of spastic hip dislocation in cerebral palsy patients.

MATERIAL AND

METHODS

We analyzed a group of 77 patients (109 hips) with hip joint dislocation (MP>80%). The patients were divided into two groups: <3 years of follow-up vs. > 3 years of follow-up. The first group thus included 64 hips (47 patients) with mean follow-up duration of 2.2 years (range 1.1-3), and the second group had 45 hips (30 patients) with mean follow-up duration of 4.8 years (range 3.2-10.2). The hips were evaluated clinically and radiographically. The relation of the femoral head to the acetabulum was described as the Acetabular Index (AI) and Reimers' migration percentage (MP).

RESULTS

In Group I, AI improved from 32.2°(17°-50°) to 22.2°(6°-45°), MP improved from 98.9% (82%-100%) to 15.9% (0%- 100%). In Group II, AI improved from 28.9° (10°-62°) to 19.4° (3°-50°). The changes in AI and MP were statistically significant. Group I demonstrated a reduction in the flexion contracture from 21.1° (0°-50°) to 10.7° (0°-30°), an increase in abduction from 19.5° (0°-60°) to 29.9° (0°-60°), and a decrease in the popliteal angle from 52.0° (0°-100°) to 34.2° (0°-85°). Group II showed a reduction in the flexion contracture from 24.6° (0°-60°) to 12.6° (0°-40°), an increase in abduction from 17.3° (-25°-80°) to 26.1° (-15°-80°), and a decrease in the popliteal angle from 61.4° (0°-120°) to 40.7° (10°-100°). These improvements were statistically significant.

CONCLUSION

Open reduction of the hip joint combined with derotation-varus femoral osteotomy and Dega pelvic osteotomy is a very effective treatment in spastic hip joint dislocation. We observed no statistically significant deterioration of results between the groups.