The purpose of the study is to evaluate the retrospective results of 92 surgically treated spastic hips. Twenty-one patients were able to walk in the community with aids, 19 were able to walk about the house, and 13 were wheelchair bound. The mean age at the time of the operation was 7 yrs (3–18) and the average follow-up was 5. The cohort of the study included 45 tetraplegic patients, 6 diplegic, and 2 hemiplegic. The dislocated hips were 25 and the subluxated ones 67.

The surgical treatment included soft tissue and bone procedures. The 53 patients were divided into two age groups: those less than 7yrs old and those older than 7yrs. The cohort was also divided into 39 patients operated in one setting, and 14 operated in more than one. Clinical evaluation was based on the joint range of motion, the ambulatory status and the pain. The radiological evaluation criteria were based on Reimer's migration index, the center-edge angle, Sharp's angle, and neck-femoral angle. We used the interclass correlation coefficient to measure our interobserver reliability for MI 0,93, for CE angle 0,95 and for Sharp's angle 0,81, as the interobserver difference for MI averaged 9% for CE angle 7and for Sharp's angle 3.

Statistical analysis of continuous variables was done by Student's t-test or the Wilcoxon rank sum test. Categorical variables were evaluated by Fisher's test. Concerning the walking ability, from the 13 severe quadriplegic patients, none improved his functional level but they achieved better sitting balance. The walking ability of the rest of the patients improved one level in 78% of the cases. The mean preoperative abduction was improved from 24,7 to 33,5, the mean flexion was slightly reduced from 123 preoperatively to 114 postoperatively and the mean extension reduced from −20 preoperatively to −8 postoperatively. Reimer's index reduced from 67,2 to 21,7 postoperatively, the CE angle increased from −10,6 to 20,5, the Sharp's angle increased from 36,9 to 40,5 and the neck-shaft angle increased from 119,7 to 157,5post-operatively. Of greater significance were MI and CE at p<0.05. A migration index of >50% at final follow-up was associated with a worse migration index and a worse CE angle at 1 year post-operatively. 46 hips were evaluated as good, 30 as satisfactory, and 16 as poor. The severe tetraplegic with small-negative CE angle and Reimer's migration index > 50%, as well as the small age of the patients (<7 yrs) were negative prognostic factors. Better results were observed when patients were operated at age <7yrs by soft tissue procedures and MI<30%, while patients >7yrs had satisfactory results only after combined bony and soft tissue procedures and MI <50%. A migration index of >50% at final follow-up was associated with a worse migration index and a worse CE angle at 1 year postoperatively.

The equinovarus hind foot deformity is one of the most common deformities in children with spastic paralysis and is usually secondary to cerebral palsy. Split posterior tibialis tendon transfer is performed to balance the flexible spastic varus foot and is preferable to posterior tibialis lengthening, as the muscle does not loose its power and therefore the possibility of a valgus or calcaneovalgus deformity is diminished. The cohort of the study consisted of 50 children with cerebral palsy who underwent split posterior tibial lengthening to manage spastic equinovarus hind foot deformity. Our inclusion criteria were: ambulatory patients with cerebral palsy, age less than 6 years at the time of the operation, varus deformity of the hind foot during gait, flexible varus hind foot deformity, and the follow-up at least 4 years. We retrospectively evaluated 33 ambulant patients with flexible spastic varus hind foot deformity. Twenty-eight patients presented unilateral and 5 bilateral involvement. The mean age at the time of the operation was 10,8 years (6–17) and the mean follow-up was 10 years (4–14). Eighteen feet presented also equinus hind foot deformity, requiring concomitant Achilles cord lengthening. Clinical evaluation was based on the inspection of the patients while standing and walking, the range of motion of the foot and ankle, callus formation and the foot appearance using the clinical criteria of Kling et al. Anteroposterior and lateral weight-bearing radiographs of the talo-first metatarsal angle were measured. The position of the hind foot was evaluated according to the criteria of Chang et al for the surgical outcome. 20 feet were graded excellent, 14 were graded good and 4 were graded poor. Feet with recurrent equinovarus deformity or overcorrection into valgus or calcaneovalgus deformity were considered as poor results. There were 23 feet presenting concomitant cavus foot component that underwent supplementary operations performed at the same time with the index operation. None of the feet presented mild or severe valgus postoperatively, while 4 feet presented severe varus deformity and underwent calcaneocuboid fusion sixteen and eighteen months after the index operation. On the anteroposterior and lateral weight-bearing radiographs the feet with severe varus had a negative talo-first metatarsal angle (mean −26,8 ± 18,4), those with mild varus had a mean of −14,5 ± 12,2. In feet with the hind foot in neutral position the mean value was 5.0 ± 7.4. The results of the feet in patients with hemiplegic pattern were better and significantly different than the diplegic and quadriplegic ones (p = 0.005). The results in our cases were in general satisfactory as 34 out of 38 feet were graded excellent and good. The feet with poor results presented a residual varus deformity due to intraoperative technical errors.

The objective of this study is to determine if surgical lengthening of the hamstrings and gastrocnemius/Achilles complex, affect muscle tone in patients with cerebral palsy. The question is if the dynamic component of muscle length changes after orthopedic surgery. A retrospective study was performed on ambulatory children with cerebral palsy who underwent either hamstring lengthening or gastrocnemius/Achilles tendon lengthening. A total of 135 consecutive patients with an average age of 13 years were included in the study. A single random side was selected for children with bilateral surgery and the affected limp was analyzed for those undergoing unilateral surgery. The popliteal angle was performed with a quick and slow stretch, as well as, the ankle dorsiflexion, and measured with a goniometer.

The difference between initial grab with fast stretch, and end of range (EOR) with slow stretch was used as a measure of spasticity. The Bohanon modification of the Ashworth score was also assessed. 18° popliteal angle improvement in end of range and 32° improvement in quick stretch in the hamstrings group were notice postoperatively, with change in slow stretch, quick stretch and Δml (comparison between quick and slow stretch) being significant at p< .0001. In the triceps surae group, 14° ankle dorsiflexion improvement in end of range, and 18° improvement in quick stretch were noticed postoperatively, with change in slow stretch, quick stretch and Δml at p< .0001, p< .0001, and p< .0180 respectively. Asworth scale was reduced by at least one grade in 89% of subjects in the hamstring group and 78% of subjects in the triceps surae group of the children with preoperative Asworth 3 and above. We concluded that significant decreases in spasticity were observed following tendon lengthening in children with cerebral palsy and that the orthopedic surgery can affect both static and dynamic components of muscle tightness in these children.