Page 16 - Delaware Medical Journal - May/June 2020

Prosthetic Interposition Arthroplasty:
Salvage Procedure for Hips in Non-ambulatory Children with Cerebral Palsy
Mutlu Cobanoglu, MD; Brian Po-Jung Chen, PT, MD; Kenneth J. Rogers, PhD, ATC; Lucio Perotti, MD; Freeman Miller, MD
Purpose: The aim of this study was to investigate whether prosthetic interposition arthroplasty with shoulder components is an effective salvage procedure to manage hip pain resulting from this degeneration with dislocation in non-ambulatory children with cerebral palsy.
Methods: A review of all published case series was combined with our own previously unpublished cases. Inclusion criteria were published cases in peer-reviewed publications and our cases since 1999 who underwent interposition arthroplasty for the treatment of painful hips due to degeneration and dislocation with a minimum one-year follow up. Data on the children’s demographic features, surgeries, and complications were summarized.
Results: Data on 48 hips (34 patients) from three previous publications were combined with 15 hips (13 patients)
from our current series. The mean age of these 47 children was 16 years (range, 11-19 years). Follow-up time ranged from 12 to 120 months. Fourteen patients had bilateral arthroplasty. All surgeries except one (hip degeneration with
20% migration index) were performed due to painful degenerated hips with dislocation. Reasons for revision included infection, inadequate femoral resection, further femoral shortening, prominent prosthesis, osteolysis, recurrent soft-tissue contracture, and heterotopic ossification. All hips were painful preoperatively and 51 (81%) were painless at last clinical follow-up. Improvement in different grades in hip range of motion, sitting ability, perineal hygiene, and reduction of pain was obtained.
Conclusion: In non-ambulatory children with cerebral palsy, prosthetic interposition arthroplasty with shoulder components decreases pain and improves hip range of motion, sitting ability, and perineal hygiene.
Keywords: children, interposition arthroplasty, non-ambulatory, spastic hip disease
INTRODUCTION
Hip instability is one of the most

with non-ambulatory cerebral palsy (CP). The incidence of hip instability increases proportionally with the System (GMFCS) level.1 Progressive neuromuscular hip displacement is often treated with soft-tissue or bony reconstructive surgery, with the goal of achieving and maintaining mobile, painless, and reduced hips.2 In the setting of failed reconstructive surgery or presentation with severe joint degeneration leading to pain, salvage options including proximal femoral resection-interposition arthroplasty,3-5 valgus osteotomy with or without
resection of the femoral head and neck,6-8 arthrodesis,9 and total hip replacement (THR)10,11 or prosthetic interposition arthroplasty with shoulder prosthesis12-14 are considered. In these children, hip pain causing discomfort in sitting, perineal hygiene, lying, and sleeping is the major complaint caused by degeneration. The common aim of these treatment methods is to palliate pain and pain-related problems and gain painless mobility and functional position of the hip. However, there is
no consensus about which procedure provides the best outcome.
Recently, prosthetic interposition arthroplasty has gained popularity.15 However, most of the previous studies
with systematic reviews primarily focused on resection arthroplasty techniques.12,16-18 Moreover, there are limited reports of the outcome of interposition arthroplasty.13-15 In our facility, this procedure was performed for all cases with painful hips due to severe degeneration believed to have unreconstructable dislocation or failed previous hip reconstructions in GMFCS IV and V level patients with CP.
The aim of the study was to investigate whether prosthetic interposition arthroplasty with shoulder prosthesis is an effective salvage procedure to manage the pain in non-ambulatory children with CP by review of the literature.
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Del Med J | May/June 2020 | Vol. 92 | No. 3
Abstract