Combined realignment procedure (femoral and acetabular) of the hip joint in ambulatory patients with cerebral palsy and secondary hip dislocation.

In a retrospective study we evaluated the results of 11 patients with cerebral palsy and concomitant hip dislocation who were still able to walk. They had been surgically treated with proximal femoral osteotomy (varization and derotation) and acetabular osteotomy (triple osteotomy) in order to achieve stabilization of the hip joint. The patients' mean age was 14.4 +/- 3.7 years. The female:male ratio was 7:4. All 11 hip joints were successfully stabilized. The range of passive abduction significantly increased from 20 degrees preoperatively to 42 degrees postoperatively. The range of flexion slightly decreased from 101 degrees to 92 degrees. Internal rotation significantly decreased from 51 degrees to 37 degrees. External rotation increase from 27 degrees preoperatively to 41 degrees postoperatively. Preoperatively 4 of the 11 patients had been able to walk without any walking aids; 7 had been able to walk with support. Concerning the ambulatory status, mild improvement was achieved postoperatively in 3 patients. The CCD-angle decreased significantly from 138.9 degrees preoperatively to 118.7 degrees postoperatively. The migration index according to Reimers improved significantly from 50.2% preoperatively to 24.2% postoperatively. Prior to surgery 4 cases showed a grade 1 dislocation, 6 cases a grade 2 dislocation, and 1 case a grade 3 dislocation. We succeeded in performing a complete reposition in all patients. Preoperatively the CE- angle was only -3 degrees (+/- 11.3 degrees) and was improved to 27.1 degrees (+/- 5.3 degrees). The ACM-angle measured 45.4 degrees preoperatively and 49.5 degrees postoperatively. The sitting balance was improved in all patients. Furthermore the problem of anal care was reduced.