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Clinical Orthopaedics and Related Research®

, Volume 470, Issue 5, pp 1294–1302 | Cite as

Multilevel Surgery Improves Gait in Spastic Hemiplegia But Does Not Resolve Hip Dysplasia

  • Erich Rutz
  • Elyse Passmore
  • Richard Baker
  • H. Kerr Graham
Symposium: Current Approaches in Cerebral Palsy, A Focus on Gait Problems

Abstract

Background

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.

Questions/purposes

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).

Results

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.

Conclusions

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.

Keywords

Cerebral Palsy Acetabular Dysplasia Gross Motor Function Classification System Pelvic Obliquity Migration Percentage 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgments

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].

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Copyright information

© The Association of Bone and Joint Surgeons® 2011

Authors and Affiliations

  • Erich Rutz
    • 1
    • 2
    • 3
  • Elyse Passmore
    • 2
    • 3
  • Richard Baker
    • 4
  • H. Kerr Graham
    • 2
    • 3
    • 5
    • 6
  1. 1.Department of OrthopaedicsUniversity Children’s Hospital Basle UKBBBasleSwitzerland
  2. 2.The Hugh Williamson Gait LaboratoryThe Royal Children’s HospitalParkvilleAustralia
  3. 3.Murdoch Children’s Research InstituteParkvilleAustralia
  4. 4.The University of SalfordSalfordUK
  5. 5.Department of Orthopaedic SurgeryThe Royal Children’s HospitalParkvilleAustralia
  6. 6.The University of MelbourneCarltonAustralia

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