OUTCOMES OF PALLIATIVE ORTHOPEDIC SURGERY FOR HIP DISLOCATION IN PATIENTS WITH CEREBRAL PALSY

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Abstract

Introduction. Hip dislocation is the key problem in patients with severe cerebral palsy (GMFCS IV, V) older than 10 years that affects life quality and limits functional capabilities. In the present study the authors evaluated the efficiency of the proximal femoral resection arthroplasty (pfra) and valgus proximal osteotomy of the femur (VPOF) associated with femoral head resection for pain control, improvement of postural management, hygiene and verticalization with total weight-bearing and correction of accompanying orthopaedic deformities. Material and мethods. A retrospective study compared two groups of patients where PFRA (7 cases, 13 hips) or VPOF (14 patients, 23 hips) were performed. Level V of GMFCS was reported in 10 patients, and level IV of GMFCS – in 11 patients. The mean age at time of surgery was 15.3±3.9 y.o. PFRA was performed in 7 cases (13 joints) and VPOF – in 14 patients (23 joints). Results. The authors did not observe any difference between the methods in respect of pain control, postural management, comfortable sitting position and hygiene. The verticalization with total weight-bearing and life quality improvement was achieved only after PVOF with femoral head resection associated with simultaneous knee and foot deformity correction performed according to the principles of Single-Event Multilevel Orthopedic Surgery. Conclusion. Both palliative methods allow to control pain syndrome, to achieve satisfactory postural management, comfortable sitting position and hygiene. But only VPOF with simultaneous knee and foot deformity correction provides possibility to verticalize the patient with weight-bearing using different orthopedic devices.

About the authors

R. R. Bidyamshin

Ilizarov Russian Scientific Center «Restorative Traumatology and Orthopedics» 6, ul. M. Ulyanova, Kurgan, 640014, Russia

Email: dpopkov@mail.ru
graduate student Russian Federation

S. O. Ryabykh

Ilizarov Russian Scientific Center «Restorative Traumatology and Orthopedics» 6, ul. M. Ulyanova, Kurgan, 640014, Russia

Email: dpopkov@mail.ru
Dr. Sci. (Med), the Head of the Scientific and Clinical Laboratory of Axial Skeleton Pathology and Neurosurgery Russian Federation

G. M. Chibirov

Ilizarov Russian Scientific Center «Restorative Traumatology and Orthopedics» 6, ul. M. Ulyanova, Kurgan, 640014, Russia

Email: dpopkov@mail.ru
junior researcher Russian Federation

D. A. Popkov

Ilizarov Russian Scientific Center «Restorative Traumatology and Orthopedics» 6, ul. M. Ulyanova, Kurgan, 640014, Russia

Author for correspondence.
Email: dpopkov@mail.ru
Dr. Sci. (Med), the Head of the Neuroorthopaedic Clinic Russian Federation

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