Roentgenoanatomy of the hip joint following reconstructive intervention in children with spastic cerebral palsy

Tomov A.D., Teplenky M.P., Aranovich A.M., Chibirov G.M., Popkov D.A.

Abstract


Objective
Explore changes in roentgenoanatomical parameters of the pediatric hip joint following multilevel reconstructive surgeries performed for CP patients in combination with derotation varus osteotomy (DVO) alone or DVO and acetabuloplasty (AP).
Material and methods
The study included 49 children (30 GMFCS level IV and 19 GMFCS level V patients). Either DVO (n = 28, 44 joints, mean age 6.98 ± 2.2 years) or DVO and AP (n = 21, 38 oints, mean age 7.0 ± 2.04 years) were produced in combination with multilevel reconstructive surgeries to eliminate contractures of the knee and ankle joints and correct foot deformities. The acetabular angle, the Reimers' index, the acetabular depth ratio (ADR), the Wiberg center-edge angle were measured preoperatively, straight after surgery and at 1, 2, 3 years postsurgery.
Results
Normal relationship between the femoral head and acetabulum persisted at a long-term follow-up. The parameters evaluating acetabular morphology (Wiberg angle, AI and ADR) were shown to improve or remain stable. The mean annual increase in the Reimers' index was not more than 3 % after DVO and not more than 2% following DVO and AP. A reverse statistically significant correlation was detected between the AI and Wiberg angle after DVO alone or DVO combined with AP throughout the observation period. This sort of correlation facilitated beneficial development of the operated hips at a long term following reconstructive interventions. Moderate correlation was observed in changed AI values after DVO at 3 years postsurgery and changes in the Wiberg angle at three-year observation comparing relative measurement changes and the age when surgery was performed. Age appeared to have a minor effect on the development of the hip following multilevel procedures produced for the cohort of patients.
Conclusion
Appropriate conditions should be provided for normal development of the hip to address hip dislocation using growth-remaining potential and remodeling the articular ends. Single-event multilevel surgery involving hip reconstruction and addressing knee and ankle contractures is practical for providing favorable conditions for postural management and passive verticalization of patients to maintain axial loading on the limbs.

Keywords


hip dislocation, cerebral palsy, single-event multilevel orthopedic surgery

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DOI: http://dx.doi.org/10.18019/1028-4427-2020-26-1-50-56

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