S3103 SOFT TISSUE SURGERY IN THE UNSTABLE JUVENILE HIP

Abstract

Aims: Several authors reported better results after combined tenotomy of hip flexors and adductors in cerebral palsied (CP) children than by isolated tenotomy of adductors. Prospective study involving 45 children (90 hips) was performed in this research project. Methods: 45 children with spastic form of CP in the age range of 2–13 years (preoperative Reimer’s index in 25 hips 0–24%, in 38 hips 25–39%, in 18 hips 40–59%, in 9 hips over 60%) were submitted to combined adductor and flexor release. All patients were postoperatively immobilised in broomstick POP cast for 6 weeks and cured by night splinting for at least 6 months postoperatively. Routine x-rays were taken before operation, after removal of POP cast and 3–5 years after operation, all in strictly neutral position. Results: Mean Reimer’s index correction was 16%, maximally 49% in 76 out from 90 affected hip joints. CE angle correction ranged from 3 to 48 degrees. Postoperative changes of both parameters were statistically siginificant. Using Vojta kinesiologic grading 41 children (91%) became improved. The proportion of walkers/non walkers changed from 9/36 to 27/18. Conclusions: In this cohort the correction of Reimer’s index under 39% was achieved in 96% of all treated patients. Many patients benefited from the operation becoming walkers. Adequate soft tisue procedure offers a very good possibility how to reduce the rate of osteotomies in CP patients.