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Complications of Hip Treatment in Children with Cerebral Palsy

  • Freeman Miller
Living reference work entry

Abstract

Children with cerebral palsy can have multiple complications in the course of managing the hips during growth. Most of these complications are mild and delay the full recovery, but a few cause a long decrease in physical function and pain. Late diagnosis or delayed treatment is the most severe complication because it allows the hips to develop arthritis which makes the outcome of subsequent treatment less good. Other complications include the possibility of a wound infection; most heal with wound management and antibiotics with no impact on the eventual outcome. Prolonged pain after hip surgery may be due to the prominent hip plate, from arthritis as the hip joint is healing, from heterotopic bone formation, or from an undiagnosed fracture. The treatment is based on developing a good diagnosis of the pain and addressing hip pain with steroid injections if it persists for 3–4 months. Some of the children have problems eating and sleeping at night. This is best managed with nonnarcotic pain medication and amitriptyline hydrochloride (Elavil). Fractures after hip surgery may occur and are more common if the child was placed into a hip spica cast, which is seldom needed. Identifying the fracture and doing appropriate treatment will provide a good outcome. Nonunion and delayed union of the osteotomy, avascular necrosis, and heterotopic bone formation are rare complications that can usually be managed with temporary activity restriction and treating the pain.

Keywords

Cerebral palsy Hip arthritis Nonunion Delayed union Femur fracture Heterotopic ossification Embolism Thrombophlebitis Hip pain Infection Leg length difference Hip stiffness 

References

  1. Banovac K (2000) The effect of etidronate on late development of heterotopic ossification after spinal cord injury. J Spinal Cord Med 23:40–44CrossRefGoogle Scholar
  2. Beauchesne R, Miller F, Moseley C (1992) Proximal femoral osteotomy using the AO fixed-angle blade plate. J Pediatr Orthop 12:735–740CrossRefGoogle Scholar
  3. Dhawale AA, Karatas AF, Holmes L, Rogers KJ, Dabney KW, Miller F (2013) Long-term outcome of reconstruction of the hip in young children with cerebral palsy. Bone Joint J 95-B:259–265CrossRefGoogle Scholar
  4. Freed JH, Hahn H, Menter R, Dillon T (1982) The use of the three-phase bone scan in the early diagnosis of heterotopic ossification (HO) and in the evaluation of Didronel therapy. Paraplegia 20:208–216Google Scholar
  5. Haefeli M, Huber H, Dierauer S, Ramseier LE (2010) Fixation of subtrochanteric extending/derotational femoral osteotomies with the Locking Compression Plate in ambulatory neuro-orthopaedic patients. J Child Orthop 4:423–428CrossRefGoogle Scholar
  6. Hesketh K, Leveille L, Mulpuri K (2016a) The frequency of AVN following reconstructive hip surgery in children with cerebral palsy: a systematic review. J Pediatr Orthop 36:e17–e24CrossRefGoogle Scholar
  7. Hesketh K, Sankar W, Joseph B, Narayanan U, Mulpuri K (2016b) Inter-observer and intra-observer reliability in the radiographic diagnosis of avascular necrosis of the femoral head following reconstructive hip surgery in children with cerebral palsy. J Child Orthop 10:143CrossRefGoogle Scholar
  8. Jozwiak M, Marciniak W, Piontek T, Pietrzak S (2000) Dega’s transiliac osteotomy in the treatment of spastic hip subluxation and dislocation in cerebral palsy. J Pediatr Orthop B 9:257–264CrossRefGoogle Scholar
  9. Knaus A, Terjesen T (2009) Proximal femoral resection arthroplasty for patients with cerebral palsy and dislocated hips: 20 patients followed for 1–6 years. Acta Orthop 80:32–36CrossRefGoogle Scholar
  10. Koch A, Jozwiak M, Idzior M, Molinska-Glura M, Szulc A (2015) Avascular necrosis as a complication of the treatment of dislocation of the hip in children with cerebral palsy. Bone Joint J 97-B:270–276CrossRefGoogle Scholar
  11. Krum SD, Miller F (1993) Heterotopic ossification after hip and spine surgery in children with cerebral palsy. J Pediatr Orthop 13:739–743CrossRefGoogle Scholar
  12. Lee M, Alexander MA, Miller F, Steg NL, McHugh BA (1992) Postoperative heterotopic ossification in the child with cerebral palsy: three case reports. Arch Phys Med Rehabil 73:289–292Google Scholar
  13. McCarthy RE, Simon S, Douglas B, Zawacki R, Reese N (1988) Proximal femoral resection to allow adults who have severe cerebral palsy to sit. J Bone Joint Surg Am 70:1011–1016CrossRefGoogle Scholar
  14. McNerney NP, Mubarak SJ, Wenger DR (2000) One-stage correction of the dysplastic hip in cerebral palsy with the San Diego acetabuloplasty: results and complications in 104 hips. J Pediatr Orthop 20:93–103Google Scholar
  15. Miller F, Girardi H, Lipton G, Ponzio R, Klaumann M, Dabney KW (1997) Reconstruction of the dysplastic spastic hip with peri-ilial pelvic and femoral osteotomy followed by immediate mobilization. J Pediatr Orthop 17:592–602CrossRefGoogle Scholar
  16. Nakajo M, Endo H (1969) Heterotopic ossification with hemiplegia caused by cerebral apoplexy. Seikei Geka 20:1193–1201Google Scholar
  17. Oh CW, Presedo A, Dabney KW, Miller F (2007) Factors affecting femoral varus osteotomy in cerebral palsy: a long-term result over 10 years. J Pediatr Orthop B 16:23–30CrossRefGoogle Scholar
  18. Payne LZ, DeLuca PA (1993) Heterotopic ossification after rhizotomy and femoral osteotomy. J Pediatr Orthop 13:733–738CrossRefGoogle Scholar
  19. Perlmutter MN, Synder M, Miller F, Bisbal R (1993) Proximal femoral resection for older children with spastic hip disease. Dev Med Child Neurol 35:525–531CrossRefGoogle Scholar
  20. Rink P, Miller F (1990) Hip instability in spinal cord injury patients. J Pediatr Orthop 10:583–587CrossRefGoogle Scholar
  21. Rutz E, Brunner R (2010) The pediatric LCP hip plate for fixation of proximal femoral osteotomy in cerebral palsy and severe osteoporosis. J Pediatr Orthop 30: 726–731CrossRefGoogle Scholar
  22. Seegenschmiedt MH, Goldmann AR, Wölfel R, Hohmann D, Beck H, Sauer R (1993) Prevention of heterotopic ossification (HO) after total hip replacement: randomized high versus low dose radiotherapy. Radiother Oncol 26:271–274CrossRefGoogle Scholar
  23. Thomas BJ, Amstutz HC (1987) Prevention of heterotopic bone formation: clinical experience with diphosphonates. Hip 1987:59–69Google Scholar
  24. Ushmann H, Bennett JT (1999) Spontaneous ankylosis of the contralateral hip after unilateral adductor tenotomy in cerebral palsy. J Pediatr Orthop B 8:42–44Google Scholar
  25. Widmann RF, Do TT, Doyle SM, Burke SW, Root L (1999) Resection arthroplasty of the hip for patients with cerebral palsy: an outcome study. J Pediatr Orthop 19:805–810Google Scholar
  26. Zhou L, Camp M, Gahukamble A, Khot A, Graham HK (2015) Cannulated, locking blade plates for proximal femoral osteotomy in children and adolescents. J Child Orthop 9:121–127CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.AI DuPont Hospital for ChildrenWilmingtonUSA

Section editors and affiliations

  • Freeman Miller
    • 1
  1. 1.AI DuPont Hospital for ChildrenWilmingtonUSA

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