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Multilevel Surgery Improves Gait in Spastic Hemiplegia But Does Not Resolve Hip Dysplasia

  • Symposium: Current Approaches in Cerebral Palsy, A Focus on Gait Problems
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Multilevel orthopaedic surgery may improve gait in Type IV hemiplegia, but it is not known if proximal femoral osteotomy combined with adductor release as part of multilevel surgery in patients with hip dysplasia improves hip development.

Questions/purposes

We asked whether varus derotational osteotomy of the proximal femur, combined with adductor release, influenced hip development in patients with Type IV hemiplegia having multilevel surgery.

Patients and Methods

We retrospectively reviewed 11 children and adolescents with Type IV hemiplegia who had a proximal femoral osteotomy due to unilateral hip displacement to correct gait dysfunction between 1999 and 2006. The mean age at the time of surgery was 11.1 years (range, 7 to 16 years). We obtained the Movement Analysis Profile and Gait Profile Score before and after surgery. We also measured the Migration Percentage of Reimers and applied the Melbourne Cerebral Palsy Hip Classification System (MCPHCS). The minimum followup was 2 years 3 months (mean, 6 years 6 months; range, 2 years 3 months to 10 years 8 months).

Results

The majority of gait parameters improved but hip development was not normalized. According to the MCPHCS at last followup, no hips were classified as Grade I, two hips were classified as Grade II, and the remainder were Grade III and IV.

Conclusions

Unilateral surgery including a proximal femoral osteotomy improved gait and walking ability in individuals with spastic hemiplegic cerebral palsy. However, hip dysplasia persists.

Level of Evidence

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank Mary Sheedy for the help in the preparing and editing the manuscript and the staff of the Hugh Williamson Gait Laboratory for the kinematic data, especially Jill Rodda [JR] and Pam Thomason [PT].

Author information

Authors and Affiliations

  1. Department of Orthopaedics, University Children’s Hospital Basle UKBB, PO Box CH-4031, Basle, Switzerland

    Erich Rutz MD

  2. The Hugh Williamson Gait Laboratory, The Royal Children’s Hospital, Parkville, VIC, Australia

    Erich Rutz MD, Elyse Passmore MEng & H. Kerr Graham MD

  3. Murdoch Children’s Research Institute, Flemington Road, Parkville, VIC, Australia

    Erich Rutz MD, Elyse Passmore MEng & H. Kerr Graham MD

  4. The University of Salford, Salford, UK

    Richard Baker PhD

  5. Department of Orthopaedic Surgery, The Royal Children’s Hospital, Parkville, VIC, Australia

    H. Kerr Graham MD

  6. The University of Melbourne, Grattan Street, Carlton, VIC, Australia

    H. Kerr Graham MD

Authors
  1. Erich Rutz MD
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  2. Elyse Passmore MEng
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  3. Richard Baker PhD
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Corresponding author

Correspondence to Erich Rutz MD.

Additional information

Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This work was performed at The Hugh Williamson Gait Laboratory.

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Rutz, E., Passmore, E., Baker, R. et al. Multilevel Surgery Improves Gait in Spastic Hemiplegia But Does Not Resolve Hip Dysplasia. Clin Orthop Relat Res 470, 1294–1302 (2012). https://doi.org/10.1007/s11999-011-2079-4

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