Page 18 - Delaware Medical Journal - May/June 2020
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Figure 2 This panel shows a 13-year-old male who has quadriplegic-type cerebral palsy. He has a painful right hip dislocation. On preoperative anteroposterior radiograph, the right femoral head is extremely degenerative with minimal remaining articular cartilage (a). On anteroposterior hip radiograph immediately after surgery, the hip replacement is complicated with intraoperative femoral fracture treated with plate and cable fixation (b); the periprosthetic fracture is healed. The right hip prosthesis is dislocated four months after hip replacement (c). On anteroposterior hip radiograph seven years after hip replacement, the right hip remains dislocated but pain free and mobile (d).
A
other 18 children (20 hips) were treated between 2000 and 2014. Three of these were excluded because their follow-up time was less than one year. Two of these children underwent implant removal and proximal femoral resection due to infection immediately after hip replacement and therefore did not have the minimum one- year follow-up; they were not assessed
in the study group but were accepted as complications of this procedure.
Thirteen children with a mean age of
16 years (range, 11 to 19 years) with a minimum one-year follow-up met the inclusion criteria. Eight children were children who underwent bilateral surgery and 11 who had unilateral hip surgery
Follow-up averaged 50 months (range, 12-108 months). Bilateral operations were performed in the same stage. All children
level V according to GMFCS. No child had had a previous salvage procedure. Seven hips had previous attempts to reduce and reconstruct and eight hips had no previous surgical intervention. Total joint replacement with shoulder components was performed in 11 of the hips and three of the 14 surgeries were hemiarthroplasty. The mean estimated blood loss was 905 ml
(range, 100-1,720 ml). Hospitalization was a mean 7.9 ± 4.6 days (range, 4-19 days).
Eleven of the 13 children had at least one
pulmonary disease, gastrostomy tube, and osteopenia. In the clinical assessment, pain inferred from crying or prolonged facial grimacing was the major complaint of the children, leading to inability of sitting (six children), lying (two children), and diapering (six children). Pain was aggravated by hip movement in seven children. However, only six children required pain medication. Windswept deformity was present in nine out of
13 children and 11 (seven prior to hip replacement, four after hip replacement) had spinal fusion due to scoliosis. The abduction was 80 degrees (range, 50-90 degrees) and 7 degrees (range, -40-30 degrees), respectively. All children had complete relief of pain in the hips and nine of these children were comfortable in the sitting position. One patient without pain continued to have persistent poor diapering due to contralateral adductor contracture in and abduction was 95.5 degrees (range, 90- 110 degrees) and 31 degrees (range, 20-45 degrees), respectively.
In the radiological assessment, migration
percentage was 100% in 14 hips (13 with degeneration), and 20% in one hip with severe hip degeneration preoperatively. Postoperatively, one hip remained were dislocated on the last radiographic assessment.
Intraoperatively, one hip surgery was complicated with femoral fracture that caused delayed rehabilitation, and one hip surgery was complicated with vein injury that caused 800 ml of blood loss. One hip was revised due to repeated leading to stiffness in the hip four years after the index surgery. Two hips had asymptomatic type 2 HO on the last radiological assessments. Two hips underwent contracture release due to patient exhibited failure of the implants and periprosthetic osteolysis. One child had pancreatitis after discharge from the hospital, and one child had systemic postoperatively, which led to a long hospitalization.
In summary of the literature, 18 articles about hip arthroplasty in patients with CP case series of prosthetic implants (three shoulder implant, and 12 standard total
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Del Med J | May/June 2020 | Vol. 92 | No. 3
