Article

The everyday life of a non-ambulatory adolescent or young adult
with cerebral palsy can be severely impaired by a painful or stiff hip. The usual
surgical solutions such as proximal femoral resection (PFR) are not entirely
satisfactory for pain relief, and are mutilating. A retrospective
study assessed the impact of total hip replacement (THR) on such impairment, on
the hypothesis that it is more effective than PFR in relieving pain, without
aggravating disability. METHODS: The surgical technique consisted in
implanting a dual-mobility prosthesis with uncemented acetabular component and
cemented femur, after upper femoral shaft shortening and short hip-spica cast
immobilization. Forty THRs were performed in 33 patients, including 31 with
multiple disability. Follow-up assessment focused on change in functional status,
pain, and range of motion. RESULTS: Mean follow-up was 5 years. Pain was more or
less entirely resolved. Improvement in range of motion was less striking, and
there was no significant change in functional status. There were 2 general, 2
septic and 10 mechanical complications, 6 of which required surgical revision.
DISCUSSION: In non-ambulatory cerebral palsy, THR provided much better
alleviation of pain than found with PFR treatment. It should be reserved for
patients able to withstand fairly long surgery and with femur size compatible
with implantation of a femoral component, however small. LEVEL OF EVIDENCE: IV,
retrospective study.
CI - Copyright (c) 2016 Elsevier Masson SAS. All rights reserved.

Langue : ANGLAIS