Acta Chir Orthop Traumatol Cech. 2021; 88(2):95-100 | DOI: 10.55095/achot2021/017
Simultaneous Bilateral Femoral Osteotomies in Neurogenic Hip Instability: a Feasibility StudyOriginal papers
- 1 Klinika dětské ortopedie, traumatologie a ortopedie, Fakultní nemocnice Brno a Lékařské fakulty Masarykovy univerzity v Brně
- 2 Oddělení ortopedie a traumatologie, AGEL Středomoravská nemocniční a.s., Nemocnice Přerov
- 3 Ortopedická klinika Lékařské fakulty Univerzity Palackého v Olomouci a Fakultní nemocnice Olomouc
PURPOSE OF THE STUDY:
The study aimed to evaluate the intraoperative and early postoperative response to simultaneous bilateral femoral osteotomy usually accompanied by soft tissue release of hip joints, or open reduction, capsuloplasty, pelvic osteotomy or extraarticular shelf procedure.
MATERIAL AND METHODS:
A bilateral surgery was performed in 16 children. Twelve children suffered from (spastic) cerebral palsy and there was one case of paralytic dislocation in a patient with myelomeningocele, while the remaining patients suffered from chromosome I aberrations, Dandy-Walker syndrome and merosin-deficient muscular dystrophy. GMFCS Level IV and V prevailed. The patients with femoral head deformity or severe adduction contracture were removed from the study group. In all cases the LCP Pediatric Hip Plate 3.5 or 5.0 (Synthes) was used for osteosynthesis. The postoperative fixation by a hip spica cast was applied for 6 weeks, after which in most cases SWASH orthosis was used at night. The age of the patient, the hip joint finding, the GMFCS level and the type of procedure were recorded.
RESULTS:
The evaluation took into account the use of general anaesthesia only or a combination of general and epidural anaesthesia, most often through caudal block, duration of surgery, time when blood transfusion was necessary and the volumes of blood needed, duration of stay in the Anaesthesiology and Resuscitation Unit, or Intensive Care Unit. As a response to surgery, the changes in haemoglobin levels in g/l and VAS pain score were studied. In four patients only the operative time exceeded 3 hours. Blood transfusion was necessary in 13 patients, with one blood unit being always sufficient. Two patients were admitted to the Anaesthesiology and Resuscitation Unit, the remaining patients spent 1-3 days after surgery in the ICU. The average length of hospital stay did not exceed a week. The postoperative decrease in haemoglobin levels quickly improved. The pain intensity was regularly recorded postoperatively and on day 3-4 it was evaluated as moderate, with patients responding well to common analgesics (VAS 4-7).
DISCUSSION:
The evaluation of duration of simultaneous bilateral procedure, postoperative recovery based on the need for blood transfusion, changes in blood count and VAS scores indicated that the procedure performed on both hip joints simultaneously does not significantly exceed the reasonable limits in terms of the patient s burden. In literature, we found only a single article on a topic of this sort, the conclusions of which are very similar.
CONCLUSIONS:
The simultaneous bilateral femoral osteotomy can be considered a fairly safe procedure.
Keywords: hip joint instability, simultaneous femoral osteotomy, cerebral palsy
Published: April 15, 2021 Show citation
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References
- Agarwal KN, Chen C, Scher DM, Dodwell ER. Migration percentage and odds of recurrence/subsequent surgery after treatment for hip subluxation in pediatric cerebral palsy: a meta-analysis and systematic review. J Child Orthop. 2019;13:582-592.
Go to original source...
Go to PubMed...
- Brunner R, Baumann JU. Long-term effects of intertrochanteric varus-derotation osteotomy on femur and acetabulum in spastic cerebral palsy: an 11- to 18-year follow-up study. J Pediatr Orthop.1997;17:585-591.
Go to original source...
Go to PubMed...
- Buxbom P, Sonne-Holm S, Ellitsgaard N, Wong C. Stability and migration across femoral varus derotation osteotomies in children with neuromuscular disorders. Acta Orthop. 2017;88:198-204.
Go to original source...
Go to PubMed...
- Canavese F, Emara K, Sembrano JN, Bialik V, Aiona MD, Sussman MD. Varus derotation osteotomy for the treatment of hip subluxation and dislocation in GMFCS level III to V patients with unilateral hip involvement. Follow-up at skeletal maturity. J Pediatr Orthop. 2010;30:357-64.
Go to original source...
Go to PubMed...
- Deignan BJ, Washburn S, Pilc E, Tuten HR. An alternative fixation method for femoral varus derotational osteotomy in spastic cerebral palsy: the Rush rod. J Pediatr Orthop B. 2020;29:22-28.
Go to original source...
Go to PubMed...
- Hägglund G, Lauge-Pedersen H, Persson Bunke M, Rodby-Bousquet E. Windswept hip deformity in children with cerebral palsy: a population-based prospective follow-up. J Child Orthop. 2016;10:275-279.
Go to original source...
Go to PubMed...
- Junior FF, Abreu FP, Neves DL, Kertzman PF, Zuccon A, De Oliveira Bittencourt S, Lopes DML. Treatment of paralytic hip dislocation among spastic quadriplegic cerebral palsy patients by means of femoral and pelvic osteotomy, without opening the joint capsule (capsuloplasty). Rev Bras Ortop. 2015;45:181-185.
Go to original source...
Go to PubMed...
- Morris C, Bartlett D. Gross Motor Function Classification System: impact and utility. Dev Med Child Neurol. 2004;46:60-65.
Go to original source...
- Noonan KJ, Walker TL, Kayes KJ, Feinberg J. Noonan KJ, Walker TL, Kayes KJ, Feinberg J. Effect of surgery on the nontreated hip in severe cerebral palsy J Pediatr Orthop. 2000;20:771-775.
Go to original source...
Go to PubMed...
- Ohsawa S, Ueno R. Middle-term results of simultaneous bilateral femoral osteotomies for advanced bilateral coxarthritis. J Orthop Sci. 2006;11:485-490.
Go to original source...
Go to PubMed...
- Owers KL, Pyman J, Gargan MF, Witherow PJ, Portinaro NM. Bilateral hip surgery in severe cerebral palsy (a preliminary review). J Bone Joint Surg Br. 2001;83:1161-1167.
Go to original source...
- Ozkul B, Camurcu Y, Sokucu S, Yavuz U, Akman YE, Demir B. Simultaneous bilateral correction of genu varum with Smart frame. J Orthop Surg (Hong Kong) 2017;25:1-5.
Go to original source...
Go to PubMed...
- Park H, Abdel-Baki SW, Park KB, Park BK, Rhee I, Hong SP, Kim HW. Outcome of femoral varus derotational osteotomy for the spastic hip displacement: implication for the indication of concomitant pelvic osteotomy. J Clin Med. 2020;9:256-26.
Go to original source...
Go to PubMed...
- Poul J, Pešl M, Pokorná M. Léčba instabilních kyčlí u DMO kostními operacemi. Acta Chir Orthop Traumatol Cech. 2004;71:360-365.
Go to PubMed...
- Poul J, Urbášek K, Ročák K. Porovnání přesnosti korekce proximálního femuru klasickými úhlovými dlahami a systémem kanalizovaného pediatricko-ortopedického instrumentaria (CAPOS). Acta Chir Orthop Traumatol Cech. 2013;80:43-46.
Go to original source...
Go to PubMed...
- Ročák K, Poul J, Urbášek K. Přesnost korekce proximálního femuru LCP dětskými kyčelními dlahami. Acta Chir Orthop Traumatol Cech. 2013;80:273-277.
Go to original source...
Go to PubMed...
- Rutz E, Brunner R. The pediatric LCP hip plate for fixation of proximal femoral osteotomy in cerebral palsy and severe osteoporosis. J Pediatr Orthop. 2010;30:726-731.
Go to original source...
Go to PubMed...
- Rutz E, Passmore E, Baker R, Graham HK. Multilevel surgery improves gait in spastic hemiplegia but does not resolve hip dysplasia. Clin Orthop Relat Res. 2012;470:1294-1302.
Go to original source...
Go to PubMed...
- Schejbalová A, Havlas V. Výkony na svalech - ovlivnění klinického a rentgenového nálezu v oblasti kyčelního kloubu u pacientů s dětskou mozkovou obrnou. Acta Chir Orthop Traumatol Cech. 2008;75:355-362.
Go to original source...
Go to PubMed...
- Šindelářová R, Poul J. Prevence rozvoje instability kyčelního kloubu u pacientů se spastickou formou dětské mozkové obrny. Acta Chir Orthop Traumatol Cech. 2001;68:176-183.
Go to PubMed...
- Sung KH, Kwon SS, Chung CY, Lee KM, Cho GH, Park MS.: Long-term outcomes over 10 years after femoral derotation osteotomy in ambulatory children with cerebral palsy. Gait Posture. 2018;64:119-125.
Go to original source...
Go to PubMed...
- Takeuchi R, Mutsuzaki H, Shimizu Y, Mataki Y, Kamada H. Soft-tissue release for hip subluxation and dislocation in cerebral palsy. J Rural Med. 2017;12:120-125.
Go to original source...
Go to PubMed...
- Terjesen,T. Femoral and pelvic osteotomies for severe hip displacement in nonambulatory children with cerebral palsy: a prospective population-based study of 31 patients with 7 years follow-up. Acta Orthop. 2019;90:614-621.
Go to original source...
Go to PubMed...
- Towns M, Rosenbaum PL, Palisano RJ, Wright FV. Should the GMFCS be used outside of cerebral palsy? Dev Med Child Neurol. 2017;60:147-154.
Go to original source...
Go to PubMed...