Valgus Osteotomy (Without Head Resection) for Chronic Neuromuscular Hip Dislocation

Abstract

The chronically painful dislocated hip in the nonambulatory spastic adolescent presents a difficult treatment dilemma. This may lead to intractable pain, decreased sitting tolerance, problems with perineal hygiene, and decubitus ulcers. Ideally, a hip reconstruction consisting of a varus shortening derotation femoral osteotomy along with a pelvic osteotomy and an open reduction of the hip would achieve adequate anatomy, but the femoral head in a long-standing hip dislocation has often destroyed cartilage surface and is grossly misshapen, thereby precluding any type of successful reconstruction.

Most would agree that pain is the primary surgical indication for these hips, but not every dislocated hip is painful. The incidence of pain in a chronic spastic hip dislocation ranges from 18 to 55%. Conservative measures such as muscle relaxant medication, modifying wheelchair positioning, botulinum toxin injection, and intrathecal baclofen should first be attempted. Should these measures fail to alleviate the pain, then a salvage surgical solution must be addressed.

Many surgical procedures have been reported to treat this condition with various success rates. These procedures include proximal femoral resection arthroplasty, subtrochanteric valgus osteotomy with or without femoral head resection, and prosthetic replacement. The aim of this chapter is to describe the technique of the modified Hass subtrochanteric valgus osteotomy popularized by Hogan in which the femoral head is not resected.