Purpose of the review: Hip dislocation and subluxation in the patient with cerebral palsy remain challenging problems to address. Difficulties arise in predicting which hips will dislocate, which dislocated hips will be problematic, and how to prevent and treat displaced hips. This article reviews the literature published in the English language over the past year that addresses these issues.
Recent findings: One of the most commonly measured radiographic parameters of acetabular dysplasia, Reimer’s migration percentage, was noted to have moderate inter- and intra-measurer error. The natural history of hip dislocations and subluxations was explored to help better define the need for early intervention. Several studies showed at least early improvement in subluxation with the use of botulinum toxin type A injections or intrathecal baclofen. Early adductor tenotomy was noted to decrease the need for later osseous procedures. Based on increases in neck-shaft angles after varus derotational osteotomy, an algorithm for initial corrected neck-shaft angle was created. A new periacetabular osteotomy was described for treatment of neuromuscular hip dysplasia.
Summary: Continued advances in our knowledge regarding hip dislocation and subluxation in the cerebral palsy population will help us identify which patients need surgery, which surgery is indicated, and how we can avoid orthopaedic surgery with alternative treatments. This article provides a review of the literature published over the past year that helps us in the prevention and treatment of neuromuscular hip dislocations.
Current Opinion in Orthopedics. 16(6):478-483, December 2005.