Proximal Femoral Head Resection and Interpositional Arthroplasty
Despite preventative screening programmes in some countries, hip dislocation is still a common problem in many severely affected, non-ambulant patients with cerebral palsy. There are two scenarios where pain and stiffness affect all aspects of patient comfort and care and where a proximal femoral excision with an interpositional arthroplasty (myoplasty) must be considered: (1) the enlocated hip following hip reconstruction that is associated with a poor clinical outcome and (2) the dislocated hip, which due to anatomical or clinical factors is not reconstructible. Both indications are most common in patients assessed as IV or V on the Gross Motor Function Classification Scale (GMFCS).
Where pain, difficulty sitting in a wheelchair for more than about 45–60 mins and/or perineal care are significant problems, proximal femoral excision with interposition myoplasty and aggressive management of the associated tonal abnormalities will reduce pain, ease care and improve sitting tolerance to 3 h or more. Examples of both scenarios are described.
KeywordsProximal femoral excision Cerebral palsy Non-ambulatory Interpositional arthroplasty
- Leet AI, Chhor K, Launay F, Kier-York J, Sponseller PD. Femoral head resection for painful hip subluxation in cerebral palsy: is valgus osteotomy in conjunction with femoral head resection preferable to proximal femoral head resection and traction? J Pediatr Orthop. 2005;25(1):70–3.PubMedGoogle Scholar