Virtual Conference
Pediatrics 2022

Verasak Taumkunanon

Queen Sirikit National Institute of Child Health, Thailand

Title: Bilateral Hip Reconstruction Correct Hip Displacement, Hip contracture and improve mobility function in cerebral palsy : Short and long term outcome


Hip contracture is a common problem in pateint with cerebral palsy. It create problems that interfere with ability to move, whether sitting, standing or walking, from imbalanced muscle leading to hip dysplasia causing the hip to displace from its cup. The hip joint may eventually be damaged and painful. Hip displacement may begin to appear before the onset of hip contracture at the age of 5 years and may progress until eventually dislocating. Hip surveillance should be performed in all children with cerebral palsy especially those with non ambulation. Correcting hip displacement with simple soft tissue release may only help in patients with mild grade hip displacement but hip reconstruction, varus derotation and shortening osteotomy (VDRSO) of proximal femur and may be combined with acetabular osteotomy, could help correct the hip in place regardless of the displacement. As long as the femoral head is not damaged, which occurs in case of hip dislocation for a long time, hip reconstruction can’t solve this problem. A hip resection arthroplasty may be performed instead to address the pain. Hip displacement, most of them tend not to move out equally on both sides. The opposite side that dose not displace beyond normal dose not mean that the hip bone and muscle are normal. There may be hip dysplasia or contracture, even if the femoral head stay in place. Correction of a displaced side may seem reasonable, but the contralateral side that has dysplasia and contracture can lead to poor overall mobility and finally progress to displacement. Both hip reconstruction works well outside of correcting the hip dysplasia and hip contracture, and it also balances the pelvis, prevent the contralateral hip displacement and increase the ability to sit and stand better than correcting only the displacing side. In one of my study of 49 patients undergoing both hip reconstruction, it was found that in addition to the hip reconstruction, the pelvic obliquity was also improved. The ability to sit was greatly improved, more than 50% of the patients had better sitting. In another study, we compared 42 patients underwent bilateral hip reconstruction and 18 patients underwent unilateral reconstruction in cerebral palsy with unilateral hip displacement. The average evaluation period is 3 years. We found that the rate of recurrent displacement was 22%, compared to only 2.4% in the bilateral group, and with 27% of the pelvic obliquity angle above 5 degree, compared to only 7% in the bilateral group. Including the ability to sit, stand or walk in the group with bilateral reconstruction clearly had better results. Recurrent hip displacement and recurrent hip contracture are a major obstacle in correcting hip displacement in cerebral palsy. When the patients has surgery at an early age, concern that their growth may be a contributing factor to this problem. In addition, the high degree of hip displacement pior to surgery or in nonambulate patients may also be a factor in this risk. We studied the factors influencing recurrent hip displacement and recurrent hip contracture in both short term and long term outcomes in 204 patients, almost all 373 hips, bilateral reconstruction. We found that the incidence of recurrent hip contracture was higher than of recurrent hip displacement. The recurrence factor was the group with dislocated or severe displaced hips prior to surgery, GMFCS V group, especially unable to sit, experience of surgeon in assessing appropriate hip alignment. Age of the patient affects the long term outcome. Younger patents at surgery may have more long term recurrent. Recurrent hip contracture is 20% more common than recurrent hip displacement, which is only 5%. Hip reconstruction in children with hip displacement from cerebral palsy can be achieved by more than 90% and shouldn’t wait until the femoral head collapse and pain. We should continue monitoring hip displacement by radiography and hip re-contracture by