Abstract
Hip pain in cerebral palsy is regarded to be underreported. Management of these patients at home is difficult as the patients mature. In the ‘non walker’ category, the aims of surgery are to relieve pain and to allow sitting and transfer.
Neuromuscular hips may have variable acetabular deficiencies ie) anterior /posterior / lateral. Many forms of surgical management, of varying complexity, have been described to address these problems.
To describe a new technique with multidirectional coverage that achieves pain free hips, 15 patients were reviewed over a 4 year period.
Inclusion criteria :- 1 Subluxated / dislocated hips with hip pain. 2 Patients who have failed conservative management. 3. Those not suitable for redirectional osteotomies.
A standardised technique was performed by one surgeon, at one institution.
In summary, the technique involves initially a standard derotation varus osteotomy. Via an anterior approach, a lateral iliac unicortical graft and strips of cancellous graft are harvested. The cancellous graft is laid on top of the intact capsule, in the areas of deficiency. The cancellous graft is held by the unicortical graft with a single screw.
15 patients were reviewed. Patients were categorised as ‘walkers’ (3) and ‘non- walkers’ (12.) The mean age was 13.2 years.
All patients were pain free after recovery. This was defined as not requiring analgesia and parental satisfaction.
The radiological appearances showed that all the shelves had incorporated, with satisfactory cover of the femoral head.
This technique addresses multidirectional cover of femoral head. The technique is relatively easy to perform. All the patients have achieved a pain free outcome to date.
The abstracts were prepared by Mr Richard Buxton. Correspondence should be addressed to him at Bankton Cottage, 21 Bankton Park, Kingskettle, Cupar, Fife KY15 7PY, United Kingdom
