Hip Surgery in Cerebral Palsy

Abstract

Hip pathology is one of the main orthopedic concerns in cerebral palsy (CP) patients. It has been demonstrated that correctly applied hip screening programs could significantly diminish the incidence of hip pathology. Unfortunately, in several countries, hip dislo- cation is significantly prevalent and is still a major concern in these patients. Depending on the age, the disability grade, the rehabilitation support, and the surgical strategies, results of hip treatment are variable. The ideal outcome of a stable, reduced, and long-lasting pain-free hip are not always achieved. In this chapter, we discuss theoretical and practical strategies used to treat specific CP hip dislocation. In younger children, simple femoral reorientation procedures (tenotomies with or without femoral osteotomies) promote correct acetabular remodeling. Later, surgical hip reduction can be an option even in late adolescents, and the use of capsuloplasty can lead to greater hip stability, in spite of eventual pelvis obliquity caused by associated spine pathology. Several technical tips for hip surgery are presented. It is essential that patients with CP hip problems receive proper follow-up, including rehabilitation medicine, physiotherapy, anti-spastic medication, on-time orthosis availability, and real teamwork concerned with this kind of pathology.