Spasticity used to be considered a contraindication for total hip replacement (THR) procedures. Due to the development of implants as well as surgical skills, THR became an option for the treatment of painful dislocation of the hip joint in patients with spastic plegia. The aim of this study was an evaluation of mid-term results of THR in spastic CP adolescent patients with painful hips with hip joint subluxation or dislocation. In 2014–2022, 18 pts (19 hips) with CP aged 16 to 20 years underwent THR in our department. The mean follow-up was 4 years (range: 1 – 9 years). Results were evaluated using the Gross Motor Function Scale, VAS scale in accordance with the Ashworth scale, types of implants used (dual mobility cup and not dual mobility cup), and radiological assessment (Crowe scale). Complications have been thoroughly analyzed. In 10 pts there has been an improvement in the GMFSC scale average from 1 to 2 points observed after the surgery. All pts have improved in the VAS scale average of 8 points (from 10 to 7). According to the Crowe scale repositioning of preoperative dislocation to primary acetabulum was achieved in all cases. Complications occurred in 4 cases: dislocations of 2 THR with dual mobility cup and 2 THR with non-dual mobility cup requiring revision surgery with good final result. No statistical significance was noted according to the type of cup (Mann-Whitney U Test). The most important risk factor for complications is severe spasticity. We believe, that CP pts with painful hips should be treated using THR. We didn't observe any significant differences between the types of implants. These findings may serve as a basis for the prediction of outcomes of THR treatment in this specific group of pts. Level of evidence: Case-control or retrospective comparative study-Level III
Purpose of the study: In the spastic quadriplegic non-ambulatory child, hip dislocation with severe adduction is a painful situation compromising perineal hygiene and local care as well as positioning in bed or wheel chair. We describe a method of treatment using Castle’s femoral resection-interposition arthroplasty and an external fixator to prevent proximal migration of the remnant femur. Description: Resection of the proximal femur with articulated distraction of the hip using an external fixator was performed in eight children (11 hips) with cerebral palsy. All patients (five boys, three girls, mean age 15 years) had painful neurological disorders with chronic hip dislocation incompatible with the sitting position and compromising perineal hygiene. The operation, described by Castle, consisted in subtrochanteric resection and suture of the quadriceps muscle around the femoral cut. The capsule detacted from the femur was closed around the acetabulum. The abductors were sutured between the shaft and the acetabulum in order to ensure interposition of enough soft tissue. An external fixator (Orthofix®) was installed for 90 days. This method has the advantage of producing the necessary distraction while allowing immediate mobility (hip extension flexion) and good balance in the sitting position as well as better perineal hygiene compared with the preoperative situation. At six months, there was a clear clinical improvement in terms of pain relief, tolerance to the sitting position, and perineal hygiene with a significant increase in joint motion (flexion, extension, abduction). Proximal migration of the femur was observed in one case after removing the external fixator. There were no cases of recurrent adduction deformity, stiffness or bone hypertrophy. Conclusion: Proximal resection of the femur with capsular interposition arthroplasty and articulated distraction with an external fixator decreases the pain of the dislocated spastic hip. This method is a reliable salvage alternative for
