Abstract
Europeam Group of Neuro-orthopaedic (GLAENeO), Caracas, The prevention of a dislocated hip is one of the aims of early surgery in Cerebral Palsy children, specially those severely involved. We performed a retrospective study of those cerebral palsy patients operated of adductor tenotomy between 1975 and 1995 with a total of 1474 patients. We grouped them in those who had a unilateral tenotomy and those who had a bilateral tenotomy as primary surgery. Of these only 8% had an obturator neurectomy, without walking ability, and 92 % had it not. Age at surgery varied from 6 months to 8 years of age with a mean of 4 years and 3 months. Group I: 792 patients (53.7 %) with unilateral adductor contracture, sustained a unilateral adductor tenotomy. Of these patients a total of 619 (78, 2 %) required a contralateral adductor tenotomy at a mean of 3 years and 6 months. Group II: 682 patients (46, 3 %) with bilateral adductor contracture that had a bilateral adductor tenotomy in one stage. Of the 792 patients that sustained a two stage adductor tenotomy, 123 (20%) presented a unilateral dislocated hip and of these 115 (93 %) occurred in the hip operated secondly at a mean of 1 year post tenotomy. Of the 682 patients with bilateral adductor tenotomies only 7 (1 %) had a dislocated hip 2 years post tenotomy. Of the 72 dislocated hips, 12 (59 %) were quadriplegics, 28 (22 %) were diplegic, 21 (18 %) hemiplegics and 1 (1 %) tetraplegic.
Of the 619 patients tenotomized in two stages, in 143 the diaphyseal – cervical angle was 155 ° (23,1 %), at a mean of 6 and a half years of age and 3 years post the second tenotomy. In 102 of these patients (71 %) a varus derotation osteotomy was performed in the hip operated in the second act with further dislocation of the hip in 20 cases (20 %). Of the 685 patients with bilateral tenotomy in one stage, varus derotation osteotomy was required in 68 (68 %) at a mean of 6 years of age with only a 3 % of dislocations in this group.
In view of these results we recommend a bilateral adductor tenotomy be performd regardless of a difference in the degree of contracture of both sides, thus coordinating the forces and avoid further dislocation the hip.
Local Host: British Society for Children’s Orthopaedic Surgery. Conference Theme: Congenital Deficiencies of the Lower Limb. These abstracts were prepared by A.Catterall.
