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Developmental dysplasia of the hip in cerebral palsy–surgical treatment

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Abstract

Developmental dysplasia of the hip (DDH) in cerebral palsy (CP) is very rare, and very little clinical data is available. We have analysed the results of open reduction of the hip (Howorth), acetabuloplasty (Salter, Pemberton), pelvic osteotomy (Chiari) and femoral osteotomy in the treatment of the DDH in CP patients. Radiographic assessment was based on the Severin grading classification system and measurements of migration percentage (MP) before and after surgery. Clinical results were analysed using the Ponsetti classification system in ambulatory patients. A total of 45 hips in 31 patients were treated surgically. The average age of the patients was 5.2 years (range: 2–16 years). The average follow-up was 9.6 years (range: 3–28 years). Analysis of the radiographic results according to Severin placed 35 hips (77.8%) in groups 1 and 2 and ten hips (22.2%) in groups 3 and higher. The average preoperative MP value was 78.7% and the average postoperative MP was 15.2%. Redislocation occurred in three hips. Clinical results were disappointing: based on Ponsetti assessment 14 hips (36.8%) were classified in the first three groups and 24 hips (63.2%) in the last three groups. This analysis suggests that these surgical procedures could be applied in treating DDH in CP.

Résumé

La dysplasie de hanche chez les patients présentant une infirmité motrice d’origine (IMOC) cérébrale est rare. Nous avons analysé les résultats de la réduction sanglante de hanche (Horworth), l’acétabuloplastie (Salter, Pemberton), l’ostéotomie pelvienne (Chiari) et l’ostéotomie fémorale dans le traitement de la dysplasie de hanche chez l’IMOC. Ces résultats ont été évalués selon la classification de Séverin, avec la mesure du pourcentage de migration avant et après traitement. Les résultats cliniques ont été évalués selon la classification de Ponsetti chez les patients ayant conservé la marche 45 hanches. 31 patients ont été analysés, l’âge moyen des patients est de 5,2 ans, le recul moyen a été de 9.6 ans (3 à 28). L’analyse des radiographies selon Séverin montre que 35 hanches (77.8%) sont classées dans le groupe 1 et 2, 10 hanches (22.2%) sont classées dans le groupe 3 et plus. Le pourcentage de migration pré-op est de 78.7% et 15.2% en post-op. Une reluxation est survenue dans trois hanches. Les résultats n’ont pas été satisfaisants. Selon Ponsetti 14 hanches (36.8%) ont été classées dans les trois premiers groupes et 24 hanches (63.2%) ont été classées dans les trois derniers groupes. Cette analyse nous permet de penser que ces traitements chirurgicaux peuvent être appliqués lors d’une luxation congénitale de hanche chez l’infirme d’origine cérébrale (IMOC).

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Authors and Affiliations

  1. Clinic for Orthopaedics and Traumatology, Clinical Center University of Sarajevo, Bolnicka 25, 71000, Sarajevo, Bosnia and Herzegovina

    I. Gavrankapetanovic

  2. Institute for Orthopaedic Surgery “Banjica”, Belgrade, Serbia and Montenegro

    G. Cobeljic, Z. Bajin & Z. Vukasinovic

  3. Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina

    F. Gavrankapetanovic

Authors
  1. I. Gavrankapetanovic
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  2. G. Cobeljic
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  3. Z. Bajin
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  4. Z. Vukasinovic
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  5. F. Gavrankapetanovic
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Correspondence to I. Gavrankapetanovic.

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Each author certifies that this investigation was performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki. All authors agree on the content and state that this article is original, that it has not been considered by another journal and that the material has not been previously published.

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Gavrankapetanovic, I., Cobeljic, G., Bajin, Z. et al. Developmental dysplasia of the hip in cerebral palsy–surgical treatment. International Orthopaedics (SICO 31, 561–568 (2007). https://doi.org/10.1007/s00264-006-0224-6

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  • DOI: https://doi.org/10.1007/s00264-006-0224-6

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