Minimally Invasive Correction of Proximal Femoral Valgus Deformity in Cerebral Palsy

Document Type : Original Article

Authors

1 Department of Orthopedic Surgery, Damietta Faculty of Medicine, Al-Azhar University, Damietta, Egypt.

2 Department of Orthopedic Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.

3 Department of Orthopedic Surgery, The National Institute of Neuromotor System, Cairo, Egypt.

Abstract

Background: His subluxation and other problems [valgus deformity] are common with cerebral palsy. The treatment is surgery as a role. However, the optimal method is not yet determined.
Aim of the work: Evaluating the minimal invasive varus osteotomy of hip valgus deformity in children with cerebral palsy.
Patients and Methods: A prospective study on 20 subluxated hips in 18 patients with cerebral palsy [CP] was conducted. They were treated with minimally invasive subtrochanteric varus derotation osteotomy and followed up for 6 months at least. The preoperative clinical laboratory and imaging assessment was thoroughly performed. Locally, all patients were checked for muscle tone, reflexes and hip range of motion of both lower limb joints.  Post-operative care done regularly with clinical and x-ray imaging to assess Shanz position. The final radiological assessment directed to migration percentage, acetabular index, neck shaft angle and the center edge angle of Wiberg.
Results: The mean Gross Motor Function Classification System [GMFCS] was 4.61±0.62 [and] 4.38±0.59 in pre-and post-operative periods respectively with significant reduction after surgery. Hip pain and ability to sit comfortable reduced significantly after surgery. The acetabular index and neck shaft angles were also significantly reduced after surgery, while the center edge angle of Wiberg was significantly increased after than before surgery. There were no early postoperative complications during period of hospital stay [2 days]. However, there were 3 cases of superficial wound infection. One patient of hardware failure. Finally, no deep infection reported.
Conclusion: Percutaneous varus derotation femoral osteotomy is effective and safe treatment option for hip deformity in cerebral palsy.

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