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

The aim of the study was to assess the results of posterolateral fusion (PLF) of L5/S1 level spondylolisthesis.

Materials 19 children (5 girls, 14 boys) aged 10–18 years (average 14) were treated surgically PLF in years 1985–2002. 18 cases before surgery were classified as grade I and II, 1 as grade III according to Meyerding classification. Long lasted low back pain, progression of the slippage was the main indication for operative treatment.

In every case suspension in prone position were applied before surgery.

Methods The Denis clinical classification was used to evaluate results. On radiographs we evaluated the verticalisation of the sacrum, lordosis at lumbosacral area by drawing Whitman-Ferguson, Boxall, Fernand-Fox angles. The mobility of the fused segment was estimated on the functional radiographs.

Results In clinical evaluation improvement was achieved in 18 cases, in 1 no improvement was achieved. In radiological estimation the slippage decreased in 17 cases varying from 1 grade to 39 grades (average 10 grades). In 1 case no improvment was achieved and in 1 the slippage increased (8 grades). The value of Fernand-Fox angle increased from 1 grade to 35 grades in 16 cases; in 1 no improvement was achieved and in 2 cases the value decreased. In every patient the posterior segmental union was achieved.

On MRI scans disc degeneration was observed in 2 patients.

Conlusions Our results confirm the existence of the remodeling process in the lumbo-sacral area of the spine.

We think that PLF in painful grade I and II spondylolisthesis is adequate method of treatment.