Skip to main content
SpringerLink
Log in

Hip reconstruction surgery is successful in restoring joint congruity in patients with cerebral palsy: long-term outcome

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Purpose

Neurogenic hip dislocation is frequently observed in patients with cerebral palsy (CP). If the hip is not centred but not dislocated, the hip joint can be recentered with minor operative effort. Reconstructive procedures are indicated if the femoral head is subluxated or dislocated. There are no data as to when destruction of the femoral head requires a salvage procedure or whether hip reconstruction surgery is successful in restoring joint congruity in patients with CP. Our aim was to investigate femoral head plasticity after hip reconstruction surgery in a long-term outcome study.

Methods

We studied a large cohort of patients with CP and high hip dislocation (Tönnis grade IV) before surgery. Sixty-eight patients were assessed, of whom 23 presented with bilateral high hip dislocation, and 91 complex hip reconstructions were conducted. Standardised radiographic examination was performed before and directly after surgery and at the long-term follow-up examination.

Results

Pain was the most frequent reason for complex hip-joint reconstruction (49 patients, 72 %). An impressive improvement in pain was demonstrated postoperatively. Forty-five hip joints presented aspheric incongruity postoperatively, which improved on average 7.7 years after surgery and 59 hip joints showed congruency. Only 15 % of patients experienced pain at the time of final follow-up, and that was of low intensity.

Conclusions

Early conservative treatment for hip dislocation is helpful, and operative reconstruction should also be scheduled early. Continued surveillance is necessary, and Reimers index is useful for monitoring the development of hip centering. In case of hip pain and femoral head deformity, our long-term study indicates that hip reconstruction surgery as a part of multilevel surgery improves pain and function in patients with CP and Tönnis IV hip dislocation, even if the hip joint is incongruent after operation. This incongruity improves over the long-term. If possible, a reconstruction procedure should be performed before the femoral head becomes deformed. High plasticity of the hip joint suggest that even if the femoral head is deformed, hip reconstruction can be recommended.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Soo B, Howard JJ, Boyd RN et al (2006) Hip displacement in cerebral palsy. J Bone Joint Surg Am 88:121–129

    Article  PubMed  Google Scholar 

  2. Carstens C, Niethard FU, Schwinning M (1992) Surgical treatment of hip dislocation in patients with infantile cerebral palsy. Z Orthop Ihre Grenzgeb 130:419–425

    Article  PubMed  CAS  Google Scholar 

  3. Palisano RJ, Hanna SE, Rosenbaum PL et al (2000) Validation of a model of gross motor function for children with cerebral palsy. Phys Ther 80:974–985

    PubMed  CAS  Google Scholar 

  4. Brunner R, Baumann JU (1997) Long-term effects of intertrochanteric varus-derotation osteotomy on femur and acetabulum in spastic cerebral palsy: an 11- to 18-year follow-up study. J Pediatr Orthop 17:585–591

    Article  PubMed  CAS  Google Scholar 

  5. Miller F, Slomczykowski M, Cope R, Lipton GE (1999) Computer modeling of the pathomechanics of spastic hip dislocation in children. J Pediatr Orthop 19:486–492

    Article  PubMed  CAS  Google Scholar 

  6. Hodgkinson I, Jindrich ML, Duhaut P, Vadot JP, Metton G, Berard C (2001) Hip pain in 234 non-ambulatory adolescents and young adults with cerebral palsy: a cross-sectional multicentre study. Dev Med Child Neurol 43:806–808

    Article  PubMed  CAS  Google Scholar 

  7. Braatz F, Eidemuller A, Biglari B, Doderlein L (2003) Severe hip dislocations in patients with infantile cerebral palsy–is surgical reconstruction sensible? Z Orthop Ihre Grenzgeb 141:123–124

    PubMed  CAS  Google Scholar 

  8. Dobson F, Boyd RN, Parrott J, Nattrass GR, Graham HK (2002) Hip surveillance in children with cerebral palsy. Impact on the surgical management of spastic hip disease. J Bone Joint Surg (Br) 84(5):720–726

    Article  CAS  Google Scholar 

  9. Jung NH, Heinen F, Westhoff B, Doederlein L, Reissig A, Berweck S, Linder-Lucht M, Schandelmaier S, Mall V (2011) German Abo study group. Hip lateralisation in children with bilateral spastic cerebral palsy treated with botulinum toxin type A: a 2-year follow-up. Neuropediatrics 42(1):18–23

    Article  PubMed  CAS  Google Scholar 

  10. Hägglund G, Andersson S, Duppe H, Lauge-Pedersen H, Nordmark E, Westbom L (2005) Prevention of dislocation of the hip in children with cerebral palsy. The first ten years of a population-based prevention programme. J Bone Joint Surg (Br) 87:95–101

    Google Scholar 

  11. Tönnis D (1984) Die angeborene Hüftdysplasie und Hüftluxation im Kindes- und Erwachsenenalter. Springer, Berlin Heidelberg New York

    Book  Google Scholar 

  12. Hägglund G, Lauge-Pedersen H, Wagner P (2007) Characteristics of children with hip displacement in cerebral palsy. BMC Musculoskelet Disord 8:101

    Article  PubMed  PubMed Central  Google Scholar 

  13. Soo B, Howard JJ, Boyd RN, Reid SM, Lanigan A, Wolfe R, Reddihough D, Graham KH (2006) Hip displacement in cerebral palsy. J Bone Joint Surg (Br) 88-A:121–129

    Article  Google Scholar 

  14. Hodgkinson I, Jindrich ML, Duhaut P, Vadot JP, Metton G, Berard C (2001) Hip pain in 234 non-ambulatory adolescents and young adults with cerebral palsy: a cross-sectional multicentre study. Dev Med Child Neurol 43:806–808

    Article  PubMed  CAS  Google Scholar 

  15. Knapp DRJR, Cortes H (2002) Untreated hip dislocation in cerebral palsy. J Pediatr Orthop 22:668–671

    PubMed  Google Scholar 

  16. Boldingh EJ, Jacobs-van der Bruggen MA, Bos CF, Lankhorst GJ, Bouter LM (2005) Determinants of hip pain in adult patients with severe cerebral palsy. J Pediatr Orthop B 14(2):120–125

    Article  PubMed  Google Scholar 

  17. Terjesen T, Lie GD, Hyldmo AA, Knaus A (2005) Adductor tenotomy in spastic cerebral palsy. A long-term follow-up study of 78 patients. Acta Orthop 76(1):128–137

    Article  PubMed  Google Scholar 

  18. Graham HK, Boyd R, Carlin JB, Dobson F, Lowe K, Nattrass G, Thomason P, Wolfe R, Reddihough D (2008) Does botulinum toxin a combined with bracing prevent hip displacement in children with cerebral palsy and “hips at risk”? A randomized, controlled trial.J. Bone Joint Surg Am 90(1):23–33

    Article  Google Scholar 

  19. Egermann M, Döderlein L, Schläger E, Müller S, Braatz F (2009) Autologous capping during resection arthroplasty of the hip in patients with cerebral palsy.J. Bone Joint Surg Br 91(8):1007–1012

    Article  CAS  Google Scholar 

  20. Braatz F, Eidemüller A, Wessel-Pfaff M, Döderlein L (2006) Hohe Hüftluxation bei Patienten mit ICP: Ergebnisse nach Kopfhalsresektion bzw. Angulationsosteotomie und Rekonstruktion. Man Med 44(3):193–197

    Article  Google Scholar 

  21. Canavese F, Emara K, Sembrano JN, Bialik V, Aiona MD, Sussman MD (2010) Varus derotation osteotomy for the treatment of hip subluxation and dislocation in GMFCS level III to V patients with unilateral hip involvement. Follow-up at skeletal maturity. J Pediatr Orthop 30(4):357–364

    Article  PubMed  Google Scholar 

  22. Brunner R, Baumann JU (1994) Clinical benefit of reconstruction of dislocated or subluxated hip joints in patients with cerebral palsy. J Pediatr Orthop 14:290–294

    Article  PubMed  CAS  Google Scholar 

  23. Wudbhav N, Sankar MD, David A, Spiegel MD, John R, Gregg MD, Brian J, Sennett MD (2006) Long-Term Follow-Up After One-Stage Reconstruction of Dislocated Hips in Patients With Cerebral Palsy. J Pediatr Orthop 26:1–7

    Article  Google Scholar 

  24. Egermann M, Döderlein L, Schläger E, Müller S, Braatz F (2009) Autologous capping during resection arthroplasty of the hip in patients with cerebral palsy. J Bone Joint Surg (Br) 91(8):1007–1012

    Article  CAS  Google Scholar 

  25. Muthusamy K, Chu HY, Friesen RM, Chou PC, Eilert RE, Chang FM (2008) Femoral head resection as a salvage procedure for the severely dysplastic hip in nonambulatory children with cerebral palsy. J Pediatr Orthop 28(8):884–889

    Article  PubMed  Google Scholar 

  26. Sharrard WJ, Allen JM (1975) Surgical prophylaxis of subluxation and dislocation in cerebral palsy. J Bone Joint Surg (Br) 57:160–166

    CAS  Google Scholar 

  27. Kim SM, Sim EG, Lim SG, Park ES (2012) Reliability of Hip Migration Index in Children with Cerebral Palsy: The Classic and Modified Methods. Ann Rehabil Med 36(1):33–38

    Article  PubMed  PubMed Central  Google Scholar 

  28. Schroeder K, Hauck C, Wiedenhöfer B, Braatz F, Aldinger PR (2010) Long-term results of hip arthroplasty in ambulatory patients with cerebral palsy. Int Orthop 34(3):335–339

    Article  PubMed  PubMed Central  Google Scholar 

  29. Shore BJ, Yu X, Desai S, Selber P, Wolfe R, Graham HK (2012) Adductor surgery to prevent hip displacement in children with cerebral palsy: the predictive role of the Gross Motor Function Classification System. J Bone Joint Surg Am 94(4):326–334

    Article  PubMed  Google Scholar 

  30. Kim HT, Jang JH, Ahn JM, Lee JS, Kang DJ (2012) Early results of one-stage correction for hip instability in cerebral palsy. Clin Orthop Surg 4(2):139–148

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Clinic for Orthopedics and Trauma Surgery, Heidelberg University Clinics, Heidelberg, Germany

    Frank Braatz, Matthias C. Klotz, Nicholas A. Beckmann, Sebastian I. Wolf & Thomas Dreher

  2. Department of Trauma Surgery and Orthopaedics, University Medical Center, Robert-Koch-Str. 40, 37075, Göttingen, Germany

    Frank Braatz

  3. Deutsche Klinik für Diagnostik DKD, Gastroenterology, Wiesbaden, Germany

    Annette Eidemüller

Authors
  1. Frank Braatz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Annette Eidemüller
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Matthias C. Klotz
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Nicholas A. Beckmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sebastian I. Wolf
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Thomas Dreher
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Frank Braatz.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Braatz, F., Eidemüller, A., Klotz, M.C. et al. Hip reconstruction surgery is successful in restoring joint congruity in patients with cerebral palsy: long-term outcome. International Orthopaedics (SICOT) 38, 2237–2243 (2014). https://doi.org/10.1007/s00264-014-2379-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-014-2379-x

Keywords

Search

Navigation