Published online Oct 18, 2013. doi: 10.5312/wjo.v4.i4.279
Revised: June 16, 2013
Accepted: June 19, 2013
Published online: October 18, 2013
AIM: To describe the surgical technique of and indications for percutaneous pelvic osteotomy in patients with severe cerebral palsy.
METHODS: Twenty-one non-ambulatory children and adolescents (22 hips) were consecutively treated with percutaneous pelvic osteotomy, which was used in conjunction with varus, derotational, shortening femoral osteotomy and soft tissue release, to correct progressive hip subluxation and acetabular dysplasia. The age, gender, Gross Motor Function Classification System level, side(s) of operated hip, total time of follow-up, immediate post-operative immobilization, complications, and the need for revision surgery were recorded for all patients.
RESULTS: Seventeen patients (81%) were classified as GMFCS level IV, and 4 (19%) patients were classified as GMFCS level V. At the time of surgery, the mean age was 10.3 years (range: 4-15 years). The mean Reimers’ migration percentage improved from 63% (range: 3%-100%) pre-operatively to 6.5% (range: 0%-70%) at the final follow-up (P < 0.05). The mean acetabular angle (AA) improved from 34.1° (range: 19°-50°) pre-operatively to 14.1° (range: 5°-27°) (P < 0.05). Surgical correction of MP and AA was comparable in hips with open (n = 14) or closed (n = 8) triradiate cartilage (P < 0.05). All operated hips were pain-free at the time of the final follow-up visit, although one patient had pain for 6 mo after surgery. We did not observe any cases of bone graft dislodgement or avascular necrosis of the femoral head.
CONCLUSION: Pelvic osteotomy through a less invasive surgical approach appears to be a valid alternative with similar outcomes to those of standard techniques. This method allows for less muscle stripping and blood loss and a shorter operating time.
Core tip: In severe non-ambulatory, Gross Motor Function Classification System IV and V cerebral palsy patients with acetabular dysplasia and progressive hip subluxation or dislocation, most patients can achieve a painless and stable hip when a pelvic osteotomy through a minimally invasive surgical approach is performed in conjunction with a varus, derotational, shortening femoral osteotomy and soft tissue release surgery. Pelvic osteotomy through a less invasive surgical approach appears to be a valid alternative with an outcome similar to that of standard techniques and allows for less muscle stripping and blood loss and a shorter operating time.