Early Tenotomy prevents risk of Hip Dislocation in Patients with Cerebral Palsy: a medium-term Outcome
Research Project | 4 Project Members
Cerebral palsy (CP) is a term addressing a group of disorders mostly affecting muscle tone, movement, and motor skills. It is caused by damage in the developing fetal or the child’s immature brain and leads to non-progressive spasticity, ataxia, or involuntary movements. CP is the most common pediatric disease and the leading cause of disability in children. The type of CP originates from the areas of the brain affected by the lesion.
Besides neurologic, gastrointestinal, respiratory, sleeping disorders, bone disease, oral health problems, impaired vision, hearing loss, genitourinary problems, drooling, or pain, orthopedic disorders are frequent complications associated with CP.
Regarding orthopaedic hip disorders in children with CP, hip subluxation is frequently seen, followed by hip luxation. The spasticity and muscle imbalance lead to an inward rotation, adduction, and flexion of the hip as well as a posterior pelvic tilt in CP patients. Consequently, it results in a migration of the femoral head that can lead to a subluxation of the hip. The severity of the hip subluxation correlates with greater Gross Motor Function Classification System (GMFCS) levels. Spastic muscle imbalance and the lack of weight-bearing in higher GMFCS levels lead furthermore to progressive structural changes around the hip joint.
The planned study aims to address the importance of early intervention in the prevention of hip subluxation and dislocation in CP patients. The study is going to elaborate on the influence of psoas, adductor and hamstring tenotomies in the prevention of hip dislocation and as a medium-term outcome. Following the surgery, the CP patients will be under hip surveillance with clinical examinations and AP pelvis radiographs according to the care pathways recommended by the American Academy for Cerebral Palsy. The Reimers Index, popliteal angle, hip extension as well as abduction will be monitored and evaluated. It intends to outline the factors influencing treatment outcomes, and it is warranted to refine the treatment protocols. Moreover, it is aimed to improve the support of well-located, pain-free hips, the prevention of hip dislocation and eventual bone operation and thus enhance the quality of life in children with CP.
BASEC-ID: 2023-02374
