Abstract
Purpose: This is a retrospective study, analysing the long term outcome following Chiari osteotomy and varus derotation osteotomy, which was performed as a part of one stage surgical reconstruction for painful subluxed or dislocated hips in cerebral palsy patients
Methods: Between 1986 and 1993, 12 hips in 11 patients underwent the above procedure. Adequate hip reduction was achieved in 11 hips and an acceptable reduction in the other. Immediate pain relief and subsequent improvement in range of movement of the hip, sitting posture and ease of perineal care was recorded in all. Average age at the surgery was 14.1 (9.1–17.8) years. At the recent follow-up, patients were seen along with the parents or carers and reassessed for pain, sitting comfort, mobility and ease of perineal care. Radiographs were obtained and assessed for acetabular cover, degree of femoral head lateralisation, changes in the hip joint including secondary arthritic changes
Results: At an average follow-up of 13.4 years (range 8.1–17.2 years), all patients remain pain free and continue to maintain improved sitting posture and personal hygiene. Improvement to mobility was marginal, but those who were community walkers to begin with benefited the most. No significant progressive arthritic changes or lateral migration were seen in any of the patients except one, in whom only a partial reduction was achieved. Minor joint changes were seen in 2 other patients.
Conclusions: Overall, Chiari osteotomy produces lasting benefits and the possible avascular necrosis and secondary arthritic changes in the hip joint appear to be minimal when compared with the long term benefits
Correspondence should be addressed to Cynthia Vezina, Communications Manager, COA, 4150-360 Ste. Catherine St. West, Westmount, QC H3Z 2Y5, Canada
