Periacetabular Osteotomy for Adolescent Neuromuscular Hip Dysplasia: Cerebral Palsy

Abstract

The adolescent neuromuscular patient with hip instability and dysplasia presents a treatment challenge with little guidance in the literature regarding the optimal treatment. In cerebral palsy, specifically, hip instability is the most common hip disorder and can lead to decreased physical endurance, pain, arthritis, and fixed dislocation. Generally, the pathophysiology is increased contracture of the hip adductors and hip flexor (psoas) which slowly creates an adduction and flexion contracture with slow migration of the femoral head out of the acetabulum. In ambulating cerebral palsy patients, a hip that centers and is congruent can be treated with a redirectional osteotomy with careful attention to maintain posterior coverage while improving lateral coverage. While classically redirection osteotomies are contraindicated in such cases as they typically create retroversion, an appropriately executed periacetabular osteotomy can maintain and even improve posterior coverage.