Hip dislocation in children with cerebral palsy

Hip subluxations and dislocations in patients with cerebral palsy are caused by muscular imbalance around the hip joint and appear after the infant age. They are most frequent in patients with quadriplegia who cannot walk. The appearance of the hip subluxation and dislocation in patients with cerebral palsy makes sitting and hygiene more difficult and often causes pain. Prevention of the hip subluxation and dislocation is important through an appropriate program of exercises to prevent contracture, orthoses, along with use of appropriate wheel chairs. We have to bear in mind the saying that every patient with cerebral palsy has disorder of the hip joint until it is proved otherwise. Regular radiology examinations of the hips are necessary for patients with cerebral palsy who cannot walk, once or twice a year during growth to discover hip subluxation at an early stage. Clinical hip subluxation and dislocation appear by worsening of the adduction and flexion hip contracture, and legs shortening with or without pain. Along with the radiological exposure in two directions, tridimensional computer tomography is helpful in planning further treatment. Treatment of hip subluxation and dislocation in patients with cerebral palsy is surgical. The decision for surgery should be made by a team involved in the patient’s treatment, carefully calculating the benefits and harm of the operation. The patient’s age, the stage and lengthening of the dislocation, the presence of pain, the damage and stage of deformity of the femoral head and mental status should be considered. In certain cases surgical treatment is not necessary. Surgery should balance the muscular forces around the hip and normalize the disordered anatomical balance. In younger patients with subluxations, tenotomies of the shortened muscles around the hip are sufficient. In older children depending on the stage of the femoral head migration and anatomical disorders, more complex surgery with tenotomies should be performed including open reduction, osteotomies of the proximal femur and pelvis. If more than one third of the femoral head cartilage is damaged, reconstruction of the hip joint is not indicated but resection of the proximal part of the femur along with interposition of the surrounding musculatures is implemented.