Abstract
Aim
To assess the results of Castles procedure performed at our hospital compared with those available in literature.
Introduction
Fifteen patients (19 hips) with severe disability and hip subluxation/dislocation underwent proximal femoral resection arthroplasty (Castles procedure) over a 10 year period under the care of 2 paediatric orthopaedic surgeons. We conducted a retrospective study of case series whether the surgery (Castles procedure) improved the pain levels, sitting tolerance, ability to use commode/nappy change, ease of dressing and the carers overall satisfaction with the procedure.
Patients and methods
We reviewed the surgeons' and theatre log books for patients' details. We then contacted the patients' parents/guardian by telephone, and using a set questionnaire, we obtained valuable information on how successful the surgery had been in their opinion.
Results
Out of 15 patients, 14 had severe cerebral palsy and one had severe brain damage secondary to trauma. The average age at surgery was 4.23 years (range 6–118 months). 14 patients obtained significant pain relief but one patient remained the same. 13 patients were found to have both sitting tolerance and sleeping improved. One patient suffered a pressure sore which has healed with conservative management. 2 patients had additional trimming procedure for heterotopic ossification excision. Apart from this there were no cases of skin breakdown. All patients found the bathing and dressing change was easier post operatively. 2 carers required extra help as the limbs were floppy but not a major issue compared to the overall benefits from the Castles procedure. Overall 13 carers were very satisfied with the procedure, two were satisfied and none were unsatisfied.
Conclusion
Our telephone survey shows the Castles procedure was a successful salvage procedure for painful dislocated hips in non-ambulatory patients with severe disability.
