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Orthopedic Hip Surgery for Patients with Cerebral Palsy

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Orthopedic Care of Patients with Cerebral Palsy

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Abstract

The hip is arguably the anatomic region of greatest concern in cerebral palsy. Tone, weakness, and spasticity about the hip can result in bony deformity such as increased femoral anteversion, coxa valga, and acetabular dysplasia. Muscular and tendinous pathology commonly includes hip flexion and adductor contractures. Bony and musculotendinous pathology can lead to pain, particularly when the hip is in advanced stages of subluxation or has dislocated. Functional problems are common, including difficulties with perineal care and seating, and in ambulatory children anterior pelvic tilt, pelvic obliquity, increased hip internal rotation, and scissoring may contribute to jump or crouch gait and in-toeing. Physical exam, x-rays, and selective use of gait analysis, MR, CT, and CT version studies are used to diagnose hip pathology, delineate how it is affecting gait, and develop a treatment protocol. Bracing and chemodenervation techniques to address hip pathology are addressed in more detail separately; surgical techniques to address hip pathology vary greatly with the most common techniques presented.

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Authors and Affiliations

  1. Pediatric Orthopaedic Surgeon, Hospital for Special Surgery, Weill Cornell Medical College, New York, NY, USA

    Emily Dodwell

  2. University of Virginia School of Medicine, Charlottesville, VA, USA

    Kunal Agarwal

  3. Child Health BC Hip Surveillance Program for Children with Cerebral Palsy, BC Children’s Hospital, Vancouver, BC, Canada

    Stacey Miller

  4. Division of Pediatric Orthopedics, Department of Orthopaedics, Faculty of Medicine University of British Columbia, Vancouver, BC, Canada

    Kishore Mulpuri

  5. Center for Hip Preservation, Hospital for Special Surgery, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA

    Ernest Sink

  6. Department of Orthopedics, Helen DeVos Children’s Hospital, Grand Rapids, MI, USA

    Philip D. Nowicki

  7. Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, USA

    Venkat Boddapati

  8. Columbia University, New York, NY, USA

    Roshan P. Shah

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  1. Emily Dodwell
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    Philip D. Nowicki

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Dodwell, E. et al. (2020). Orthopedic Hip Surgery for Patients with Cerebral Palsy. In: Nowicki, P. (eds) Orthopedic Care of Patients with Cerebral Palsy. Springer, Cham. https://doi.org/10.1007/978-3-030-46574-2_6

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