Abstract
Introduction: We compared femoral head resection (FHR) and traction with femoral head resection and valgus osteotomy (the McHale procedure), in order to determine the effectiveness of these two procedures in the treatment of painful hip subluxation in severely involved individuals with cerebral palsy.
Methods: Retrieval of demographic patient information, operative technique, post-operative complications, and migration of the femoral shaft was obtained from a retrospective review of charts and radiographs. Caregivers were then contacted by telephone and queried regarding post-operative changes in pain, sitting tolerance, and hygiene as well as overall satisfaction with surgical intervention.
Results: 27 patients, 36 hips comprise the study cohort; 26 patients have quadriplegia, one has diplegia and is the only patient who is ambulatory. 16 patients underwent FHR, 11 patients underwent McHale procedures. The average age of surgery was 19 years, range from 8 to 42 years. Average follow-up was 3.4 years from time of surgery. The majority of patients (17) had not undergone reconstructive hip surgery because they were lost to orthopedic follow-up, and missed the opportunity to have the hip relocated before femur was significantly deformed. Six patients had painful hips despite previous attempts at surgery, three patients refused reconstructive surgery, and one patient was not deemed medically stable enough for reconstructive surgery.
Post-operative complications were numerous and included skin breakdown, wound dehiscense, hardware infection or failure, heterotopic ossification, and death. The complication rate was significantly higher in patients who had undergone FHR and traction (13/16) compared with the patients who had a McHale procedure (3/11). The average length of hospitalization was almost twice as long for the FHR group (7 days) as for the McHale group (4 days). Telephone surveys of caregiv-ers often demonstrated equivalent overall satisfaction with surgery in both groups with average scores of 8/10 for the FHR and 7.6/10 for the McHale group (on a scale from 1 to 10, 10 being the most satisfied). Only two of the respondents (one from the FHR group, one McHale) we contacted regretted having had surgery.
Caregivers felt that post-operatively pain relief was achieved in almost all patients. The average time to achieve a more pain-free state was three months. Sitting tolerance improved variably between individual patients, while few caregivers felt that hygiene improved after surgery, although they also felt that hygiene had not been a significant problem pre-operatively.
Local Host: British Society for Children’s Orthopaedic Surgery. Conference Theme: Congenital Deficiencies of the Lower Limb. These abstracts were prepared by A.Catterall.
