Prevention of spastic paralytic dislocation of the hip.

In a retrospective review of 99 children with spastic cerebral palsy, the efficacy of soft-tissue procedures alone in reducing early subluxation of the hip and preventing further subluxation and dislocation was determined. The indication for surgery was early subluxation of one or both hips. Surgery was either adductor tenotomy with or without anterior branch obturator neurectomy, or adductor tenotomy in combination with iliopsoas recession. Results were poor for 64 per cent after adductor tenotomy and anterior branch obturator neurectomy. For patients who also had iliopsoas recession the success rate was 72 per cent. Radiographic analysis showed that uncovering of the femoral head had halted or improved in 80 per cent of patients following iliopsoas recession.