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Proximal Femoral Head Resection and Interpositional Arthroplasty

  • Elizabeth Ashby
  • Deborah M. Eastwood
Chapter

Abstract

Despite preventative screening programmes in some countries, hip dislocation is still a common problem in many severely affected, non-ambulant patients with cerebral palsy. There are two scenarios where pain and stiffness affect all aspects of patient comfort and care and where a proximal femoral excision with an interpositional arthroplasty (myoplasty) must be considered: (1) the enlocated hip following hip reconstruction that is associated with a poor clinical outcome and (2) the dislocated hip, which due to anatomical or clinical factors is not reconstructible. Both indications are most common in patients assessed as IV or V on the Gross Motor Function Classification Scale (GMFCS).

Where pain, difficulty sitting in a wheelchair for more than about 45–60 mins and/or perineal care are significant problems, proximal femoral excision with interposition myoplasty and aggressive management of the associated tonal abnormalities will reduce pain, ease care and improve sitting tolerance to 3 h or more. Examples of both scenarios are described.

Keywords

Proximal femoral excision Cerebral palsy Non-ambulatory Interpositional arthroplasty 

Suggested Reading

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of OrthopaedicsEvelina Children’s HospitalLondonUK
  2. 2.Department of Orthopaedic SurgeryGreat Ormond Street Hospital for ChildrenLondonUK

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