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chronic dislocated hip cerebral palsy

Annelieke M K Harmsen, Melinda M E H Witbreuk, Hans J E H Pruijs, Annemieke I Buizer, Johannes A van der Sluijs
Outcome after Schanz osteotomy in the treatment of chronic hip dislocation in children with cerebral palsy was evaluated. Medical charts and questionnaires were used to assess pain, functional outcome and satisfaction. A total of 24 children, with a mean age of 13.8 years (± 8.9), were included in the study, out of which 11 were classified with Gross Motor Function Classification System (GMFCS) level IV and 13 with GMFCS level V. Current pain was comparable to patients without chronic hip dislocation, and satisfaction was intermediate...
May 2016: Journal of Pediatric Orthopedics. Part B
Rafael Carboni de Souza, Marcelo Valentim Mansano, Miguel Bovo, Helder Henzo Yamada, Daniela Regina Rancan, Patricia Maria de Moraes Barros Fucs, Celso Svartman, Rodrigo Montezuma César de Assumpção
Imbalance and muscle spasticity, in association with coxa valga and persistent femoral anteversion, compromises hip development in cases of cerebral palsy and may result in chronic pain and even dislocation. Some of these hips undergo salvage surgery because of the severe impact of their abnormalities in these patients' quality of life. We conducted a systematic review of the literature to compare the results from the main hip salvage techniques applied to these individuals. The literature search focused on studies that evaluated results from hip salvage surgery in cases of cerebral palsy, published from 1970 to 2011, which are present in the Embase, Medline, PubMed, Cochrane Library and SciELO databases...
May 2015: Revista Brasileira de Ortopedia
Maximilian Martinez, Seung-Ju Kim, Sanjeev Sabharwal
BACKGROUND: Treatment of a painful, chronically dislocated hip in nonambulatory children with cerebral palsy (CP) is challenging and controversial. Although many surgical options have been described, there is limited information, including patient-centered outcomes, following treatment. The purpose of our study was to evaluate the effect of a percutaneous subtrochanteric valgus osteotomy (SVO) using external fixation (EF) on hip abduction, radiographic parameters, and quality of life (QOL) measures in such patients...
March 2017: Journal of Pediatric Orthopedics
Nirav K Patel, Sanjeeve Sabharwal, Christopher R Gooding, Aresh Hashemi-Nejad, Deborah M Eastwood
PURPOSE: Proximal femoral excision is a salvage procedure for painful chronic hip dislocation in cerebral palsy (CP) patients. The primary objective of this article is to describe our experience of an amplified interposition myoplasty, with appropriate peri-operative pain and tone management strategies, in a cohort of non-ambulatory CP patients with painful chronic hip dislocation. Our secondary objective is to present the clinical outcomes of these patients. METHODS: We describe our experience in 20 CP patients (25 procedures) at mean 54-month (range 27-169) follow-up with a surgical technique that includes an augmented interposition myoplasty and tone management...
August 2015: Journal of Children's Orthopaedics
Samuel E Kolman, Joseph J Ruzbarsky, David A Spiegel, Keith D Baldwin
BACKGROUND: No preferred procedure exists for the chronically painful, unreconstructable subluxated or dislocated hip in cerebral palsy. The purpose of this study was to compare pain relief and complication rates of salvage procedures in cerebral palsy for ambulatory and nonambulatory populations. METHODS: We searched Medline, Embase, and Cochrane databases using the search terms "cerebral palsy" and "hip dislocation." Inclusion and exclusion criteria were established to maintain data quality for analysis...
September 2016: Journal of Pediatric Orthopedics
Patricia M De Moraes Barros Fucs, Helder H Yamada
The treatment of the spastic hip in Cerebral Palsy (CP) remains a challenge especially in cases of advance changes. Many options are available and the key for a good outcome is to find the best surgical procedure to an individualized patient. The hip fusion is one of the surgical options. The authors presented a group of spastic CP with painful chronic hip subluxation and dislocation treated with hip fusion with a mean follow-up period of 14.5 years. Surgical technique, post-operative management and outcomes were shown, also with the observations done regarding the evolution of the contralateral hip after the hip fusion...
October 2014: Journal of Pediatric Orthopedics
Melanie Penner, Wen Yan Xie, Navneet Binepal, Lauren Switzer, Darcy Fehlings
OBJECTIVES: Pain in children with cerebral palsy (CP) is underrecognized, undertreated, and negatively affects quality of life. Communication challenges and multiple pain etiologies complicate diagnosis and treatment. The primary objectives of this study were to determine the impact of pain on activities and to identify the common physician-identified causes of pain in children and youth ages 3 to 19 years across all levels of severity of CP. METHODS: The study design was cross-sectional, whereby children/youth aged 3 to 19 years and their families were consecutively recruited...
August 2013: Pediatrics
Mandar Agashe, Sang-Heon Song, Xue-Bo Tong, Jin-Ho Hong, Hae-Ryong Song
Subtrochanteric valgus osteotomy has been used for painful hip joint dislocation in patients with severe cerebral palsy. The goal of this study was to evaluate 11 patients (17 hips) with severe cerebral palsy who had chronically dislocated and painful hips treated with subtrochanteric valgus osteotomy using a monolateral external fixator. A retrospective review was performed of 11 patients (average age, 17.8 years) with severe quadriplegic cerebral palsy with flexion-adduction contractures due to chronically dislocated and painful hips...
February 2013: Orthopedics
Andrew Joseph Roche, Gill Rutherford Davies, Jayanth Sampath
Pain or skin irritation due to the femoral stump after proximal femoral resection for chronic spastic hip dislocation in children with severe cerebral palsy may be encountered. We describe a technique that, to our knowledge, has been unreported earlier and can deal with this phenomenon to improve the patient's comfort level and help the patient to sit more comfortably.
March 2012: Journal of Pediatric Orthopedics. Part B
Anne Van Riet, Pierre Moens
We retrospectively studied the results achieved in adolescent and adult patients with cerebral palsy, following management of chronically painful dislocated hips with the McHale procedure. Thirteen patients with seventeen procedures were included in the study. The indication for surgery was pain in all patients. Limitation in sitting was also reported in eight cases and nursing care was difficult in ten of thirteen patients. All patients underwent clinical and radiological examination of the hips, and a questionnaire was answered by both parents and caretakers...
April 2009: Acta Orthopaedica Belgica
Andreas Knaus, Terje Terjesen
BACKGROUND AND PURPOSE: Chronic hip dislocation in non-ambulatory individuals with cerebral palsy (CP) can lead to severe problems, of which pain is often the most severe. We studied the outcome of proximal femoral resection, especially regarding pain, sitting balance, perineal care, and patient satisfaction. PATIENTS AND METHODS: During the period 1998-2005, we operated 20 non-ambulatory patients with spastic quadriplegic CP (8 females and 12 males). 13 patients had unilateral dislocation and 7 had bilateral...
February 2009: Acta Orthopaedica
Komalam Muthusamy, Heng-Yi Chu, Richard M Friesen, Pei-Chi Chou, Robert E Eilert, Franklin M Chang
BACKGROUND: Proximal femoral head resection (FHR) has been used as a treatment option in patients with cerebral palsy (CP) who suffer from pain, contractures, and impaired personal hygiene. We analyzed the overall functional outcome following this surgery and associated patient satisfaction. METHODS: This study was a retrospective case series with a follow-on questionnaire. A consecutive sample of 27 patients with CP who underwent proximal FHR between 1988 and 2004 were analyzed...
December 2008: Journal of Pediatric Orthopedics
Elizabeth A Szalay, Debra Harriman, Brittany Eastlund, Deana Mercer
BACKGROUND: Postoperative bone density loss is an accepted phenomenon that has not been objectively quantified. The extent of this bone loss is documented using preoperative and postoperative dual energy x-ray absorptiometry scans to demonstrate the magnitude of the problem and to underline the need for prevention and treatment. METHODS: Children undergoing lower extremity surgery who required a minimum of 4 weeks of either non-weight bearing or cast immobilization postoperatively were recruited to undergo preoperative and postoperative dual energy x-ray absorptiometry scans of lumbar spine and both distal femora...
April 2008: Journal of Pediatric Orthopedics
Kathleen A Hogan, Mathew Blake, Richard H Gross
BACKGROUND: Many treatments have been proposed for a painful chronically dislocated hip in a child with spasticity who is unable to walk. The valgus subtrochanteric femoral osteotomy was originally described as a treatment for a missed congenital hip dislocation in a young adult who was able to walk. The purpose of this study was to investigate the outcomes of a modified Hass subtrochanteric valgus osteotomy for the treatment of symptomatic chronic hip dislocations in patients with spasticity due to neuromuscular disorders...
December 2006: Journal of Bone and Joint Surgery. American Volume
David A Spiegel, John M Flynn
Hip problems, including progressive subluxation, dislocation, and pain, are common in patients with cerebral palsy, particularly those who are nonambulatory with a large degree of spasticity. Clinical and radiographic screening facilitates early detection, and surgery is indicated to prevent progressive dysplasia. Although an early soft tissue release may prevent progressive subluxation in a subset of cases, bony reconstructive surgery is indicated for patients with established bony deformity. Salvage procedures are recommended to treat chronic pain caused by established subluxation or dislocation...
April 2006: Orthopedic Clinics of North America
Patrícia M de Moraes Barros Fucs, Celso Svartman, Rodrigo Montezuma C de Assumpção, Paulo F Kertzman
The purpose of this study was to evaluate 14 painful dislocated hips in patients with spastic cerebral palsy, treated with hip arthrodesis and internal fixation. The mean age at the surgical procedure was 15 years and 5 months. The mean follow-up period was 5 years and 3 months. All patients showed bone union, pain relief, and postural improvement. Hip arthrodesis is a reasonable option in treating painful spastic subluxated and dislocated hips in patients with cerebral palsy, especially if it is unilateral and the patient has weight-bearing function...
July 2003: Journal of Pediatric Orthopedics
T Terjesen, C Hellum
Hip dislocation of several years duration in cerebral palsy needs treatment only if the patient has serious complaints. With the aim of reducing pain and problems with sitting function and perineal hygiene, we performed shortening osteotomy of the femur in 15 patients (12 girls and 3 boys) with spastic quadriplegia or diplegia at mean age of 14 (8-26) years. The patients were severely mentally and physically retarded, and only one patient had gait function, with support. A subtrochanteric shortening osteotomy of 3-5 cm was performed...
August 10, 1998: Tidsskrift for Den Norske Lægeforening: Tidsskrift for Praktisk Medicin, Ny Række
K A McHale, M Bagg, S S Nason
Femoral head resection with valgus subtrochanteric osteotomy was performed on six hips in five nonambulatory adolescent patients with painful, chronically dislocated hips due to spastic paralysis. This procedure was successful because it led to pain relief, ease of perineal care, and facility of seating. Complications, such as proximal migration of the remaining femur, recurrence of adduction deformity, hip stiffness, and excessive heterotopic bone formation, common to other procedures used for this condition, have not occurred...
July 1990: Journal of Pediatric Orthopedics
O Onuba, J Langa
We present two cases of spontaneous dislocation of the hip joint due to chronic osteomyelitis of the upper femur. Spontaneous hip dislocations occur in certain pathological conditions such as poliomyelitis (Ingram, 1980), cerebral palsy (Howard et al., 1985), osteomyelitis and neurofibromatosis.
March 1991: Archives of Emergency Medicine
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