Abstract
The adolescent neuromuscular patient with hip instability and dysplasia presents a treatment challenge with little guidance in the literature regarding the optimal treatment. In cerebral palsy, specifically, hip instability is the most common hip disorder and can lead to decreased physical endurance, pain, arthritis, and fixed dislocation. Generally, the pathophysiology is increased contracture of the hip adductors and hip flexor (psoas) which slowly creates an adduction and flexion contracture with slow migration of the femoral head out of the acetabulum. In ambulating cerebral palsy patients, a hip that centers and is congruent can be treated with a redirectional osteotomy with careful attention to maintain posterior coverage while improving lateral coverage. While classically redirection osteotomies are contraindicated in such cases as they typically create retroversion, an appropriately executed periacetabular osteotomy can maintain and even improve posterior coverage.
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Suggested Reading
Beck M, Woo A, Leunig M, Ganz R. Gluteus minimus-induced femoral head deformation in dysplasia of the hip. Acta Orthop Scand. 2001;72(1):13–7.
Ganz R, Klaue K, Vinh TS, Mast JW. A new periacetabular osteotomy for the treatment of hip dysplasias. Technique and preliminary results. Clin Orthop. 1988;232:26–36.
Sankar WN. Complete redirectional acetabular osteotomies for neurogenic and syndromic hip dysplasia. J Pediatr Orthop. 2013;33(Suppl 1):S39–44.
Sucato DJ. Treatment of late dysplasia with Ganz osteotomy. Orthop Clin North Am. 2006;37(2):161–71, vi.
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Zmugg, S.T., Sucato, D.J. (2018). Periacetabular Osteotomy for Adolescent Neuromuscular Hip Dysplasia: Cerebral Palsy. In: Hamdy, R., Saran, N. (eds) Pediatric Pelvic and Proximal Femoral Osteotomies. Springer, Cham. https://doi.org/10.1007/978-3-319-78033-7_9
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DOI: https://doi.org/10.1007/978-3-319-78033-7_9
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