Neurological problems such as cerebral palsy, myelomeningocele and others may lead to unstable hips in children and juvenile patients. Major problems may arise due to the inability to treat the underlying condition. Patients may suffer from spasticity, reduced muscular tone, bone loss or bony deformity. Despite these problems several tactics are used to gain long-term reduction of unstable hips.

Femoral osteotomies are done alone or in combination with pelvic osteotomies, and/or muscular procedures. The indication of the femoral osteotomy alone is the unstable hip with a normal pelvic anatomy shown in the three-dimensional computed tomography (CT). Long-term follow up (11 to 18 years) of patients with intertrochanteric femoral osteotomy alone resulted in hip centration if patients were younger than four years of age at the time of surgery. In older patients hip centration always improved but femoral osteotomies alone did not result in sufficient coverage of subluxated or dislocated hips. Therefore in these patients with pelvic deformity we perform an intertrochanteric varusderotation and shortening osteotomy to correct the femur deformity in combination with a Pemberton type peri-acetabular pelvic osteotomy, an open reduction of the hip joint and a capsuloraphy.