Parameters of radiographic coxometry in reconstructive operations on the hip joint as part of multilevel surgical interventions in children with cerebral palsy

Tomov A.D., Diachkov K.A., Popkov D.A.

Abstract


Purpose
Study the parameters of the hip joint in the short- and long-term postoperative periods in patients with severe types of cerebral palsy, accompanied by pathology of the hip joint, who underwent multilevel interventions, including its reconstruction. Study hip joints at stages depending on the interval between operations (between surgery on the first and second joints in bilateral CP), age of patients as well as an assessment of the intact jointdevelopment in unilateral dislocations.
Materials and methods
This study included 124 children with spastic types of cerebral palsy who underwent surgical orthopedic reconstructive treatment at the RISC for RTO in the period between 2012 and 2016. Their mean age at the start of treatment was 7.01 ± 2.47 years (range: 3 to 13 years). Coxometry indices were evaluated depending on the interval between operations (between surgery on the first and second joints in bilateral CP), patient's age, and the development of intact joint in unilateral CP was also studied.
Results
Multilevel interventions, including VDO and operations that restore limb weight-bearing are favorable for the development of the hip joint if the initial Reimers index is more than 40 % in both unilateral and bilateral hip dislocation. In unilateral dislocation (Reimers’ index more than 40 %) and contralateral adduction or adduction flexion contracture combined with torsion of the segment and the difference in limb length that impede postural management, even with the Reimers’ index less than 40 %, surgical treatment with VDO on the contralateral extremity provides a favorable development of the second hip joint. In unilateral VDO performance, on the contralateral limb, it is necessary to perform adductotomy in adduction contracture of the joint (without dislocation) to prevent lateralization and degradation of the situation towards subluxation. Failure to perform this element of the operation increases the risk to 11.8 % (with an age of younger than 8 years old) and to 14.3 % (8 year or older) of the progression of the migration index of more than 7 % per year or the development of hip subluxation. Moreover, by performing unilateral DVO in patients over 8 years of age, there is a risk of an increase in the Reimer’s index of the contralateral joint by more than 7 % per year, even if simultaneous bilateral adductotomy is performed.
Conclusion
In hip dysplasia requiring reconstructive intervention in children with severe cerebral palsy, hip joint surgery should be combined with restoration of bilateral muscle balance, especially adductors, as well as with elimination of contractures of the knee and ankle joints, foot deformities to create favorable conditions for postural management in early and late postoperative period.

Keywords


cerebral palsy, dislocation of the hip, multi-level single-stage orthopedic interventions, outcome, surgical treatmentt

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DOI: http://dx.doi.org/10.18019/1028-4427-2019-25-3-337-347

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