Multilevel Surgery Improves Gait in Spastic Hemiplegia But Does Not Resolve Hip Dysplasia
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Multilevel orthopaedic surgery may improve gait in Type IV hemiplegia, but it is not known if proximal femoral osteotomy combined with adductor release as part of multilevel surgery in patients with hip dysplasia improves hip development.
We asked whether varus derotational osteotomy of the proximal femur, combined with adductor release, influenced hip development in patients with Type IV hemiplegia having multilevel surgery.
Patients and Methods
We retrospectively reviewed 11 children and adolescents with Type IV hemiplegia who had a proximal femoral osteotomy due to unilateral hip displacement to correct gait dysfunction between 1999 and 2006. The mean age at the time of surgery was 11.1 years (range, 7 to 16 years). We obtained the Movement Analysis Profile and Gait Profile Score before and after surgery. We also measured the Migration Percentage of Reimers and applied the Melbourne Cerebral Palsy Hip Classification System (MCPHCS). The minimum followup was 2 years 3 months (mean, 6 years 6 months; range, 2 years 3 months to 10 years 8 months).
The majority of gait parameters improved but hip development was not normalized. According to the MCPHCS at last followup, no hips were classified as Grade I, two hips were classified as Grade II, and the remainder were Grade III and IV.
Unilateral surgery including a proximal femoral osteotomy improved gait and walking ability in individuals with spastic hemiplegic cerebral palsy. However, hip dysplasia persists.
Level of Evidence
Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
KeywordsCerebral Palsy Acetabular Dysplasia Gross Motor Function Classification System Pelvic Obliquity Migration Percentage
We thank Mary Sheedy for the help in the preparing and editing the manuscript and the staff of the Hugh Williamson Gait Laboratory for the kinematic data, especially Jill Rodda [JR] and Pam Thomason [PT].
- 6.Davids JR, Ounpuu S, DeLuca PA, Davis RB. Optimization of walking ability of children with cerebral palsy. Inst Course Lect. 2004;53:511–522.Google Scholar
- 12.Gage JR. Orthopaedic treatment of long bone torsions. In: Gage JR, Schwartz MH, Koop S, Novacheck TF, eds. The Identification and Treatment of Gait Problems in Cerebral Palsy. 2nd ed. London: MacKeith Press; 2009:473–491.Google Scholar
- 25.Novacheck T. Management options for gait abnormalities. In: Neville B, Goodman R, eds. Clinics in Dev Med No 150. Congenital Hemiplegia. London: MacKeith Press; 2000:98–112.Google Scholar
- 26.Novacheck TF. Orthopaedic treatment of muscle contractures. In: Gage JR, Schwartz MH, Koop S, Novacheck TF, eds. The Identification and Treatment of Gait Problems in Cerebral Palsy. 2nd ed. London: MacKeith Press; 2009:445–472.Google Scholar
- 34.Sharp IK. Acetabular dysplasia. The acetabular angle. J Bone Joint Surg Br. 1961;43:13–25.Google Scholar
- 38.Wiberg G. Studies on dysplastic acetabula and congenital subluxation of the hip joint. Acta Chir Scand Suppl. 1939;58:13–25.Google Scholar
- 40.Wynter M, Gibson N, Kentish M, Love SC, Thomason P, Graham HK. Consensus Statement on Hip Surveillance for Children with Cerebral Palsy. Australian Standards of Care. Available at: http://www.ausacpdm.org.au/activities/hip-surveillance. Accessed April 8, 2011.