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RESEARCH
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hip prostheses). The outcomes from the three shoulder implant articles13-15 were combined with the results of our current case series.
From these previous publications, data from 48 hips (34 patients) were combined with 15 hips (13 patients) from our current series. The age at operation ranged from 11 to 20 years (mean, 16 years). Follow-up ranged from 12 to 120 months. Fourteen patients received bilateral arthroplasty. One patient in our series underwent arthroplasty due to hip degeneration
with 20% migration index, and the
other 46 cases received arthroplasty
due to painful hip dislocation (Figure
1). All hips were reportedly painful preoperatively and 51 (81%) of 63 hips were totally painless at the last clinical follow-up. The patients had improvement in hip range of motion, sitting ability, and perineal hygiene related to the reduction in pain. Reasons for revision were infection, inadequate femoral resection, further femoral shortening, prominent prosthesis, osteolysis, recurrent soft-tissue contracture, and HO. The infection rate
of this procedure was 6%. Heterotopic hips. Reoperation rate for non-infectious reasons (soft-tissue contracture, HO, fracture, etc.) was 12% (Figure 2). A short review of the literature on standard
hip arthroplasty in patients with CP found similar complications but lower rates in mostly ambulatory adults (Figures 1 and 2).
DISCUSSION
The aim of the study was to determine whether interposition arthroplasty with shoulder prosthesis is an effective salvage procedure to manage pain in non- ambulatory children with CP. Based on this literature review and analyzing the existing patient data from our institution, we believe the goals were achieved; requiring recurrent surgery.
The primary management of hip dysplasia in children with CP should be prevention and early reconstruction to preserve the hip joint. However, in the presence of failed reconstruction and very severely neglected degenerative joints, salvage procedures should be considered. With careful monitoring, the need for hip salvage procedures is relatively rare in our practice. However, when the treatment
of a chronically dislocated, severely deformed, and painful spastic hip is required, there is no clear management protocol.21,22 to determine the level of pain in non- ambulatory children with CP who cannot
communicate verbally, although crying aloud or prolonged facial grimacing are typical indicators of pain reported by families.
In this study, we focused on hip arthroplasty with shoulder components and reviewed the literature on hip arthroplasty with either hip components or shoulder components. Our surgical procedure was performed as described
by Gabos et al.13 The proximal femur
was cut just at the level of the lesser trochanter and the ligamentum teres,
and the pulvinar were debrided from the acetabulum. If a pseudoacetabulum was present on the ilium and it articulated with the femoral head better than the
true acetabulum, it was treated as the functional acetabulum. All acetabular components were cemented into the appropriate location, but most femoral was secured to the holes in the prosthesis. Then the hip abductors were also tied directly to the prosthesis through the holes in the prosthesis. No postoperative management, such as traction, was performed to keep the prosthesis in the acetabulum.
In this cohort, 81% of the patients were totally painless at the last clinical follow-up. Gabos et al. report that 10 of 11 patients
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