Proximal femoral resection or total hip replacement in severely disabled cerebral-spastic patients.

1. Our understanding of the mechanism and origin of pain in degenerative arthritis of the hip is incomplete at this time, whether we are dealing with a neurologically intact individual or a person who has spasticity of cerebral origin. 2. Predicting whether or not a particular hip in a nonambulatory patient whose spasticity is of cerebral origin at an early age will eventually become painful at some future date is extremely difficult. Once the patient attains adolescence or adulthood, the hip may become painful whether it is located, subluxated, or dislocated. 3. In the skeletally immature patient with cerebral palsy we may be justified in operating to correct clinically relevant soft tissue and bony deformities about the hip. In the skeletally mature patient, we should operate for pain and disability, not solely for deformity. 4. We do not yet have salvage or reconstructive hip procedures that yield consistently satisfactory long-term results in severely disabled cerebral-spastic patients.