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350 VARUS DEROTATIONAL OSTEOTOMY AND CLOSED REDUCTION IN THE TREATMENT OF SPASTIC HIP DISLOCATION IN CEREBRAL PALSY.
  1. G. W. Chaus,
  2. R. M. Friesen*,
  3. K. Muthusamy*,
  4. F. M. Chang*
  1. University of Colorado School of Medicine, Denver, CO
  2. *Center for Gait and Movement Analysis, The Children's Hospital, Denver, CO.

Abstract

Summary This study presents the results of a long-term retrospective study investigating the outcomes of a varus derotational osteotomy (VDRO) without concomitant capsulorrhaphy for the treatment of spastic hip dislocation in children with cerebral palsy (CP). The patient population consisted of 57 patients (107 hips) with spastic neuromuscular hip dislocation, all with migration indices greater than 90%. All patients selected obtained adequate clinical and radiographic follow-up lasting until skeletal maturity. Medical records and radiographs were examined for the presence of complications associated with treatment of their spastic hips, as well as the need for revision procedures at the hip. Results of the study indicate that the closed reduction has few risks associated with it, as indicated by a low incidence of complications, especially serious postoperative complications such as avascular necrosis (AVN). Whereas other studies in which a concomitant capsulorrhaphy was performed showed incidences of AVN as high as 50%, this study reports AVN in only 1.8% of the patients. Even without a concomitant capsulorrhaphy, only three patients required a revision procedure, indicating that good reduction of the hip can be achieved without a capsulorrhaphy. It is the authors' opinion that if an acceptable reduction can be achieved without opening the joint capsule then performing a VDRO without a capsulorrhaphy is preferred due to the much lower incidence of AVN and other serious complications.

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