Page 17 - Delaware Medical Journal - May/June 2020

RESEARCH
PATIENTS AND METHODS
A literature search of the years 1986 to 2017 was performed in PubMed with “cerebral palsy,” “hip,” and “arthroplasty” as keywords. The published data from previously reported case series were combined with unreported cases from
our institution. For our unreported cases, the charts and radiographs of the children with non-ambulatory CP between 2000 and 2014 were reviewed after Institutional Review Board approval. Inclusion criteria were children who underwent prosthetic interposition arthroplasty with shoulder prosthesis for the treatment of painful hip due to degeneration and dislocation with a minimum one-year follow-up. Children whose clinical and radiographic data
were not retrieved from the charts, and who were treated with another salvage procedure, were excluded.
The children’s demographic features, details of surgical information, and complications were summarized. Primary clinical assessment data obtained from chart and publication review included pain, sitting ability, perineal hygiene, and range of motion of the hip. All surgeries were performed due to failed previous surgery with the complaint of severe limitation of hip motion as well as pain and pain-related problems such as sitting with perineal hygiene as a consequence of degenerative hip with or without dislocation on plain radiograph.
Descriptive analysis was used to describe the data.
RESULTS
Twenty-nine children (34 hips) who were treated between 1988 and 2014 were reviewed. Eleven (14 hips) of these were treated before 2000 and these charts were not retrieved; most of these children were included in a previous report.13 The
Del Med J | May/June 2020 | Vol. 92 | No. 3 113
Figure 1 This panel shows a female patient three years post hip reconstruction (bilateral varus derotational osteotomies of the proximal femur, right Dega periacetabular osteotomy, and right hip adductor release at 8 years old) who subsequently developed relatively severe avascular necrosis, which has healed. She is left with an adducted severely painful hip (a) and there is hip degeneration on the right side on anteroposterior radiographs and femoral head fragmentation of loose bodies on computerized tomography scans (b), axial images (c), and coronal images (d). Because of the severe deformity at
this point, we elected to do a proximal replacement with a shoulder prosthesis. The hip is located on anteroposterior right hip radiograph immediately after surgery (e); the right hip remains located on anteroposterior hip radiograph 18 months after surgery (f).
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