CONSTRAINED TOTAL HIP ARTHROPLASTY FOR PAINFUL DISLOCATION IN A PAEDIATRIC CEREBRAL PALSY PATIENT

Abstract

The management of hip instability in the non-ambulant paediatric cerebral palsy (CP) patient is complex. Subluxations and dislocations arise secondary to muscle imbalance caused by strong hip flexors and adductors overpowering weaker hip abductors and extensors. These conditions give rise to sitting problems and can cause debilitating pain making care difficult. Treatment methods include physiotherapy, abduction bracing, muscle releases and transfers, proximal femoral and pelvic osteotomies, proximal femoral excision +/- interpositional arthroplasty, arthrodesis and total hip arthroplasty (THA). THA in the adult CP patient is not uncommon, however dislocation has remained a concern. THA is rarely used in the paediatric patient and to our knowledge the use of a constrained liner, which should prevent dislocation, has never been described. We present the case of a non-ambulant paediatric CP patient with normal intelligence whom by the age 16 had been successfully managed with staged bilateral uncemented THAs using constrained liner technology.