Results of orthopedic surgery in non-ambulatory adolescents with cerebral palsy complicated by hip dislocation

Background: The aim of the study was to evaluate efficiency of the Proximal Femoral Resection Arthroplasty (PFRA) and Subtrochanteric Valgus Osteotomy of the femur (SVO) associated with femoral head resection for pain control, improvement of postural management, hygiene and verticalization with total weight-bearing.

Methods: This retrospective study compared two groups of patients undergone the PFRA (10 cases, 17 hips) and SVO (27 patients, 40 hips). Patients presented level V of GMFCS (Gross Motor Function Classification System) in 13 cases, and level IV of GMFCS in 24 cases. The mean age was 14.1 ± 2.3.

Results: We did not observe any difference between the methods from the point of view of pain control, postural management, comfortable sitting position and hygiene. The verticalization with total weight-bearing was achieved only after SVO with femoral head resection associated with simultaneous knee and foot deformity correction performed with the principles of Single-Event Multilevel Orthopaedic Surgery (SEMLS).

Conclusion: Both methods allow to control pain syndrome, to achieve satisfactory postural management, comfortable sitting position, and hygiene. But only SVO with simultaneous knee and foot deformity correction provides supported standing with weight-bearing providing mechanical loading.