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J Am Acad Orthop Surg, Vol 10, No 3, May/June 2002, 198-209.
© 2002 the American Academy of Orthopaedic Surgeons
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Management of Hip Disorders in Patients With Cerebral Palsy

John M. Flynn, MD and Freeman Miller, MD

Dr. Flynn is Assistant Professor of Orthopaedics, Division of Orthopaedic Surgery, The Children’s Hospital of Philadelphia, Philadelphia, PA. Dr. Miller is Associate Professor of Orthopaedics, Department of Orthopaedic Surgery, Alfred I. duPont Institute, Wilmington, DE.

Reprint requests: Dr. Flynn, The Children’s Hospital of Philadelphia, 34th and Civic Center Boulevard, Philadelphia, PA 19104-4399.

Hip disorders are common in patients with cerebral palsy and cover a wide clinical spectrum, from the hip at risk to subluxation, dislocation, and dislocation with degeneration and pain. Although the hip is normal at birth, a combination of muscle imbalance and bony deformity leads to progressive dysplasia. The spasticity or contracture usually involves the adductor and iliopsoas muscles; thus, the majority of hips subluxate in a posterosuperior direction. Many patients with untreated dislocations develop pain by early adulthood. Because physical examination alone is unreliable, an anteroposterior radiograph of the pelvis is required for diagnosis. Soft-tissue lengthening is recommended for children as soon as discernable hip subluxation (hip abduction <30°, migration index >25%) is recognized. One-stage comprehensive hip reconstruction is effective treatment for children 4 years of age or older who have a migration index >60% but who have not yet developed advanced degenerative changes of the femoral head. Salvage options for the skeletally mature patient with a neglected hip are limited.




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