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Irreducible dislocation of the hip in cerebral palsy patients treated by Schanz proximal femoral valgus osteotomy

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Abstract

Palliative Schanz proximal femoral valgus osteotomy is considered a common option for treatment of irreducible hip dislocation in cerebral palsy. From 1992 to 2005, Schanz osteotomy was indicated on 55 occasions in 35 nonambulatory patients with the quadriplegic form of cerebral palsy aged 9–18. Postoperatively, the main emphasis focussed on clinical presentation, improvement of hip range of motion, and pain relief. X-rays were carried out at three, six, and 12 months postoperatively with subsequent average follow up 98 ± 4.5 months. In all patients, the range of hip abduction and flexion increased. In 54 (98.2%) cases painful symptoms significantly improved. One patient (1.8%) had a subsequent femoral head excision because of persistent hip pain. Transient hip pain persisted in four patients (7.3%). Schanz valgus osteotomy improves the hip range of motion, relieves pain, and facilitates care of the patient. Schanz femoral osteotomy is a less invasive method compared to proximal femoral excision and should preferably be used in older children with neurogenic hip dislocation in whom reconstructive surgery is not indicated.

Résumé

L’ostéotomie de Schanz est considérée comme un traitement possible des luxations irréductible chez l’infirme moteur cérébral. De 1992 à 2005, une ostéotomie de Schanz a été réalisée 55 fois chez 35 patients non marchant et présentant une quadriplégie spastique, ces patients étaient âgés de 9 à 18 ans. La surveillance postopératoire a été centrée sur l’examen clinique, l’amélioration de la mobilité et l’amélioration des phénomènes douloureux. Les radios ont été réalisées à 3, 6 et 12 mois postopératoires avec un suivi moyen de 98 mois ± 4,5 mois. Chez tous les patients la mobilité de la hanche en abduction et en flexion s’est améliorée. Dans 54 cas (98,2%) la diminution de la douleur est significative. Un patient (1,8%) a nécessité d’une résection de la tête fémorale du fait de douleurs persistantes. Une douleur transitoire a persisté chez 4 patients (7,3%). L’ostéotomie de Schanz améliore la mobilité et la douleur de ces patients. Cette intervention est peu invasive comparée à la résection de l’extrémité supérieure du fémur et peut être préférée chez les enfants âgés présentant une luxation neurologique pour lesquels il n’est pas possible de réaliser une reconstruction de la hanche.

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Acknowledgement

The work was supported by grant IGA MZ NR 8333-3.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Charles University Second Medical School, V Úvalu 84, 150 06, Prague 5, Czech Republic

    Alena Schejbalova, Vojtech Havlas & Tomas Trc

  2. Department of Orthopaedic Surgery, Dumfries and Galloway Royal Infirmary, Dumfries, UK

    Vojtech Havlas

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  1. Alena Schejbalova
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  2. Vojtech Havlas
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  3. Tomas Trc
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Correspondence to Vojtech Havlas.

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Schejbalova, A., Havlas, V. & Trc, T. Irreducible dislocation of the hip in cerebral palsy patients treated by Schanz proximal femoral valgus osteotomy. International Orthopaedics (SICOT) 33, 1713–1717 (2009). https://doi.org/10.1007/s00264-008-0676-y

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  • DOI: https://doi.org/10.1007/s00264-008-0676-y

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