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Hip-joint congruity after Dega osteotomy in patients with cerebral palsy: long-term results

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Abstract

Introduction

Neurogenic hip dislocation is quite common in children with cerebral palsy (CP). The purpose of this study was to evaluate the long-term outcome of single-event multilevel surgery (SEMLS) in combination with hip reconstruction by using a periacetabular osteotomy as described by Dega concerning post-operative remodeling and plasticity of the femoral head post-operatively.

Methods

A total of 72 patients with CP as the primary disease and in whom a complex surgical hip reconstruction was performed during SEMLS between 1998 and 2004 were included in the study. There were 45 men and 27 women, with a median age of 7.6 (4.7–16.3) years at the time SEMLS was performed. The mean follow-up time was 7.7 years (4.9–11.8). X-rays were taken before and after surgery, and Rippstein 1 and 2 were used for follow-up. As the most reliable value for decentration, migration percentage (MP) as described by Reimers was used. To measure hip-joint cover at follow-up, the centre-edge angle was used. The hip was divided into four different categories according to sphericity and congruity. Using this approach, we could evaluate joint remodeling.

Results

Pre-operatively, the mean MP measured by X-ray was 68 %. Directly after surgery, this value decreased on average by 12 % and at the long-term follow-up was 16.0 % on average. A high rate of incongruence was observed on X-rays taken directly after surgery: 66 hip joints were classified as incongruent. The number of aspherical and incongruent joints decreased to 54 at the follow-up examination.

Conclusion

Data of our study with high plasticity of the hip joint suggest that even if the femoral head is deformed and a persistent incongruency after surgery is expected, hip reconstruction can be recommended.

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Authors and Affiliations

  1. Department of Orthopedic and Trauma Surgery, University Hospital Heidelberg, Heidelberg, Germany

    Frank Braatz, Matthias C. Klotz, Sebastian I. Wolf & Thomas Dreher

  2. Department of Trauma Surgery and Orthopedics, University Medical centre Göttingen, Göttingen, Germany

    Frank Braatz & Stefan Lakemeier

  3. Juraklinik Scheßlitz, Fachabteilung Chirurgie, Scheßlitz, Germany

    Daniel Staude

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  1. Frank Braatz
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  2. Daniel Staude
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  3. Matthias C. Klotz
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  4. Sebastian I. Wolf
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Correspondence to Frank Braatz.

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Braatz, F., Staude, D., Klotz, M.C. et al. Hip-joint congruity after Dega osteotomy in patients with cerebral palsy: long-term results. International Orthopaedics (SICOT) 40, 1663–1668 (2016). https://doi.org/10.1007/s00264-015-3013-2

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