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Query: UNIPROT:P50502 (Hip)
 7,003 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The two major problems of the hip in cerebral palsy relate to gait abnormalities and hip instability. Gait abnormalities are a result of muscle imbalance and should be corrected with appropriate muscle transfers and releases. Frequently, femoral anteversion may be associated with internal rotation of the limb, and if severe, should be corrected. Hip instability leading to S/D is a very serious problem in cerebral palsy and is usually worse in the more severely involved patients. Early muscle releases should be done before the hips subluxate. Once subluxation occurs, muscle releases must be combined with a varus rotation osteotomy. If acetabular insufficiency is present, pelvic osteotomy is necessary to obtain stability. In the older patient who has a painful S/D hip, the author recommends either a hip arthrodesis or a total hip replacement.
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PMID:Treatment of hip problems in cerebral palsy. 343 27

Hip muscle imbalance in cerebral palsy may cause subluxation or dislocation. Pelvic radiographs were used to assess hip stability in 40 affected hips before and after open adductor surgery. Preoperative rates of hip migration were determined from radiographs using the center-edge angle and migration percentage. Either an open adductor tenotomy with partial obturator neurectomy or a posterior adductor transfer was performed. Follow-up averaged 5 years, with a reversal of preoperative lateral hip migration in 36 of 40 hips. There was no statistically significant difference in the radiographic outcome of the two procedures. Lateral hip migration can be arrested or reversed with properly timed hip adductor surgery.
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PMID:Radiographic comparison of adductor procedures in cerebral palsied hips. 651 2

Twenty patients with cerebral palsy had a total of 35 extension contractures of the hip, resulting from tightness of the gluteus maximus or hamstring muscles, with associated quadricepts muscle spasticity. Associated deformities included anteriorly dislocated hips, patella alta, lumbar lordosis, thoracic kyphosis and calcaneus feet. Active and passive exercises, surgical release of contractures and reduction of anteriorly dislocated hips improved function. Hip flexor or adductor tenotomies must be considered cautiously for patients with spastic hip extensor muscles, because severe extension constricture may develop after either procedure.
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PMID:Treatment of extension contracture of the hip in cerebral palsy. 720 67

A prospective review of 272 institutionalized cerebral palsy residents was undertaken in order to determine the incidence and characteristics of neuromuscular scoliosis in this population. The types of cerebral palsy in the group consisted of 75% spastic, 8% dyskinetic, 4% ataxic, 8% mixed, and 5% undefined. There was a 64% incidence of roentgenographic scoliosis greater than 10 degrees. Two distinct curve patterns were determined with equal frequency, single and multiple. The significance of the curve patterns could not be determined. Scoliosis was most common in the spastic group with the highest incidence in the spastic quadriplegics. The incidence directly paralleled the severity of the neurologic deficit but also appeared to be aggravated by the effects of gravity when the individuals were artificially placed in the sitting position. There was a definite inverse relationship between the level of ambulation and scoliosis: the higher the level of ambulation the lower the incidence of scoliosis. Hip stability per se could not be correlated with the incidence of scoliosis. The most important factors in predicting scoliosis in this population are the presence of spasticity and the severity of the neurologic deficit.
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PMID:Scoliosis in the institutionalized cerebral palsy population. 733 81

Hip subluxation and dislocation in patients with cerebral palsy are challenging problems. The Chiari pelvic osteotomy has been commonly recommended as a technique for hip stabilization when acetabular dysplasia is present. We evaluated the results of Chiari osteotomy without concomitant femoral osteotomy in 24 hips in 23 patients with an average follow-up of > 7 years. Evaluation consisted of a pain and function questionnaire, chart review, physical examination, and review of serial radiographs. At final follow-up, 19 of 24 (79%) of the hips were painless, and 21 of 24 hips (88%) permitted unlimited sitting. Seven of 24 (29%) of hips, however, had a migration index of > or = 30%. Painful hips were associated with a greater migration index preoperatively, at 1 year postoperatively, and at final follow-up, and a greater height of the osteotomy above the edge of the acetabulum. Deterioration in the migration index (resubluxation) occurred largely in the first year postoperatively. Alternative acetabular procedures, simultaneous femoral osteotomies, or both may improve on these results. Long-term follow-up studies are necessary to compare the results of different treatments for spastic hip subluxation and dislocation to determine optimal treatment.
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PMID:Chiari pelvic osteotomy in cerebral palsy. 779 Apr 98

Thirty-three patients with cerebral palsy had iliopsoas transfers as part of their surgery for hip instability. All had total-body involvement, spastic cerebral palsy and none could walk. At the time of surgery, eight hips were subluxated and 39 were dislocated or severely subluxated. Mean follow-up was 8 years in patients between 8-25 years old. Forty-five of the 47 hips were located. Thirty patients had an accompanying scoliosis, and, in 10 patients, the rib cage impinged on the pelvis. Hip flexion had decreased in most patients. Sitting ability had not improved in any patient, and had in fact deteriorated in 50%.
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PMID:Iliopsoas transfer in cerebral palsy: the long-term outcome. 800 57

We prospectively studied 50 consecutive ambulatory cerebral palsy (CP) patients to determine the incidence of isthmic spondylolisthesis. In addition, we examined the relationship of hip flexion contractures to development of spondylolisthesis and low back pain. Three patients who had undergone previous spine operation were eliminated from the study group. Of the remaining 47 patients, one patient (2%) demonstrated an asymptomatic grade I spondylolisthesis. Another patient (2%) demonstrated spondylolysis without spondylolisthesis. Only six patients reported occasional low back pain. Pain did not correlate with increasing age, increasing hip flexion contracture, or decreasing sacrofemoral angle. The incidence of spondylolisthesis in this group of ambulatory CP patients with hip flexion contractures is similar to that in the general population. Hip flexion contractures did not predispose the group to spondylolisthesis or low back pain. Periodic screening of asymptomatic ambulatory CP patients for spondylolisthesis is not recommended.
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PMID:Incidence of spondylolisthesis in ambulatory cerebral palsy patients. 841 51

Controversy exists regarding the role of pelvic obliquity in hip dysplasia and cerebral palsy. Earlier authors noted such a relationship but did not confirm its existence by scientific study. The current study confirms the association of pelvic obliquity to hip dysplasia in spastic cerebral palsy. At presentation of subluxation or dislocation before surgery, 80 patients were indexed into 5 body alignment types. Reclassifications were performed with passage of time to study the natural history and effects of surgery. Hip dysplasia was found in all cases to be consistent with the forces related to pelvic obliquity.
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PMID:The cerebral palsied hip. 917 Mar 61

The goal of selective dorsal rhizotomy (SDR) is to reduce surgically abnormal excitatory impulses to the lower extremities and thus to decrease spasticity in patients with cerebral palsy. One hundred thirty-one patients underwent SDR from 1986 to 1994 and were retrospectively reviewed for changes in tone, requirements for orthopedic intervention, and changes in ambulatory status. One hundred twelve patients had adequate follow-up. Postrhizotomy tone was decreased in all of the 112 patients, as measured by the Ashworth scale. No statistically significant change in ambulatory status was found. A total of 71 (65%) of 112 patients required orthopedic intervention for continued contractures and deformity. Of those judged "hypotonic" by the physiatrist postoperatively, 37% required subtalar stabilization for severe planovalgus. Hip subluxation was noted and treated (by femoral or pelvic osteotomy or both) in 27 (25%) of 112. Despite appropriately completed SDR, parents must understand the importance of periodic long-term follow-up and the possible, if not likely, need for additional surgery to alleviate contractures and stabilize subluxation of joints.
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PMID:Orthopedic procedures after rhizotomy. 944 5

An intertrochanteric femoral osteotomy is carried out to correct intoeing gait and to improve hip centration in patients with spastic cerebral palsy. The long-term effect of such osteotomies on the neck-shaft angle (NSA) and anteversion angle (ATA), as well as on hip-joint centration, was evaluated in 63 hips of 45 patients with observation times of 11-18 years (mean, 15.4). The postoperative loss of correction of the NSA and ATA was the more pronounced the younger the patients were at the time of intervention. This was particularly true when the hip joint was subluxated or dislocated and when the operation was done before the age of 4 years. Patients of this age group lost 96% of the correction of the NSA and 42% of the ATA. Hip centration always improved, but corrective femoral osteotomy alone did not result in a sufficient coverage in cases of subluxation and dislocation in the short and long term.
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PMID:Long-term effects of intertrochanteric varus-derotation osteotomy on femur and acetabulum in spastic cerebral palsy: an 11- to 18-year follow-up study. 959 95


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