Percutaneous Proximal Femoral Osteotomy with External Fixator for Chronically Dislocated Hips in Patients with Cerebral Palsy

Abstract

Hip subluxation and dislocation is common in nonambulatory patients with cerebral palsy (CP), especially in more severe forms such as those with Gross Motor Function Classification System (GMFCS) level V. Pain, discomfort, and deformity causing difficulty with positioning and perineal care are frequent concerns among the patient’s caregivers. In the adolescent patient with CP who has a chronic dislocation and loss of femoral head sphericity, relocating the deformed head into a dysplastic acetabulum is not indicated. In such patients, salvage procedures such as hip arthrodesis, proximal femoral resection, hip arthroplasty, and proximal femoral valgus osteotomy have been reported. Subtrochanteric valgus osteotomy (SVO) has been described primarily with an open technique, but complications are common. Percutaneous SVO using an external fixator for stabilization may provide a sustained correction deformity as well as improve quality of life measures while minimizing morbidity.