Affiliations: Neuromuscular Clinic, Department of Orthopaedics and
Traumatology, Santa Casa Medical School and Hospitals, São Paulo,
Brazil
Note: [] Corresponding author: Patricia M. de Moraes Barros Fucs, M.D.,
PhD., R. Prof. Lucio Martins Rodrigues 330, ap 22. São Paulo, Brazil
05621-030. Tel.: + 55 11 9629 0808; Fax: + 55 11 3223 3422; E-mail:
patricia@fucs.com.br
Abstract: Introduction: The purpose of this study was to evaluate the long
term results of 19 painful dislocated hips in patients with spastic cerebral
palsy (CP) who were treated with hip arthrodesis and internal fixation. Patients and Methods: The study included 19 patients with spastic CP
with a mean age of 17 years and five months (min 10+11 and max 30+8) at the
time of surgery. There were 11 tetraplegics, 5 diplegics, 2 diplegics with
athetosis, and one hemiplegic. Functionally, 4 patients were community
ambulators, 2 were household, and 13 were non-ambulators. Six patients had
previous hip procedures prior to arthrodesis. The main surgical indications
were pain and too much joint destruction to reconstruct the hip. The mean
follow-up period was 11 years and one month. Results: All patients showed bone union and pain relief, and
postural improvement was seen in almost all patients. Four patients needed
revision, with implant change and bone graft for delayed union. In two cases,
the hip arthrodesis ended up being converted into a Castle procedure due to
difficulties in positioning and/or increasing spinal deformity. Conclusion: Hip arthrodesis is a reasonable option in treating
painful spastic subluxated and dislocated hips in CP, primarily in unilateral
cases and in patients with ambulatory ability.
