Neurogenic hip in cerebral palsy - the effect of orthopedic surgery on muscles in the hip joint region
Abstract
Introduction: Increasing incidence of neurogenic luxations of the hip joint in patients with cerebral palsy leads to combined surgeries on muscles - adductors and flexors of the hip in the effort to prevent progression of lateral migration. Material: In 1999-2002, 289 patients (a total of 589 hip joints) were indicated for surgical treatment on muscles in the hip region at the Orthopedic Clinic of 2nd Medical Faculty, Charles University and Faculty Hospital Motol, Prague.
Methods: Surgical approaches include isolated and combined procedures on muscles - adductors (in. adductor longus, in. gracilis) and flexors (in. iliopsoas, in. rectus femoris) of the hip with follow-up clinical and X-ray evaluation using migration per cent value and Wiberg center-edge (CE) angle 2 and 6 months after surgery. Results: Best clinical and X-ray results were achieved in children 6 years and younger.
In combined procedures on adductor muscles and in. rectus femoris, a significant improvement in centration (30-90 %) was achieved in 51.7 %, in combination with in. iliopsoas tenotomy, in 55.6 %. Wiberg CE angle increased in group 1A (children 6 years and younger and 30 % migration) in combined procedures on average by 11degrees, after concurrent in. iliopsoas release by 15degrees.
In the 2nd and 3rd age group (under 12 years, 13 years and above, respectively), clinical improvement is apparent but X-ray findings are not markedly significant, especially in age 10 and above. Discussion: Procedures on muscles in cerebral palsy patients are the basic procedures that can improve centration of the hip or prevent migration progression.
The best results were achieved in patients under 6 years using combined surgeries on adductors and flexors of the hip. Active and timely operative approach can prevent procedures on bones.