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Soft-Tissue Release for Spastic Hip Subluxation in Cerebral Palsy

1997; Lippincott Williams & Wilkins; Volume: 17; Issue: 5 Linguagem: Inglês

10.1097/00004694-199709000-00003

1539-2570

Freeman Miller, Rita Cardoso Dias, Kirk W. Dabney, Glenn E. Lipton, Mark Triana,

Botulinum Toxin and Related Neurological Disorders

Children with spastic hip subluxation secondary to cerebral palsy were treated with a standard protocol that focused on early detection of the subluxation using physical examination and anteroposterior pelvis radiographs. Using limited hip abduction of < or =30 degrees and subluxation of > or =25% migration percentage as indications, patients had open adductor and iliopsoas lengthenings with immediate postoperative mobilization and no abduction bracing. The protocol was applied to 74 children with a mean age of 4.5 years and had 147 hips surgically addressed. Of these hips initially, 20% were normal (migration percentage or =60%). At a final postoperative follow-up of 39 months, 54% of these hips were classified as good (migration percentage or =40%). Of this patient population, 69% were nonambulators and their outcomes were not statistically different from children who could walk. No child developed an abduction contracture or wide-based gait that required treatment. With early detection and applying this treatment algorithm, 80% of children with spastic hip disease should have good or fair outcomes. Longer follow-up will be required to determine how many children will need bony reconstruction to maintain stable and located hips at the conclusion of growth.