In the last post, we discussed the different surgical procedures that are typically performed for the treatment of hip disorders in children with cerebral palsy. Parents are always concerned about the complications associated with these procedures. I will discuss the common complications of these procedures in this post
1- Bleeding requiring blood transfusion: Like any other surgery, hip surgery in children with cerebral palsy can result in blood loss requiring blood transfusion.The risk of this complication is highest in young children undergoing procedures involving reshaping of the pelvis. The risk of blood loss requiring blood transfusion is typically less than 10%. The children on seizure medications may loose more blood during surgery due to the effect of seizure medications on blood.
2-Wound infection: With the current universal use of antibiotics before surgery, wound infection is not a common complication and can typically be treated with antibiotics by mouth. Children with a history of prior MRSA infection, may benefit from receiving a different type of antibiotics prior to surgery. Please mention the history of infection to your physician before surgery.
3- Recurrence: After reconstruction, unfortunately hips may still dislocate in children with cerebral palsy due to the continued spasticity. This risk is highest in children with higher levels of involvement (GMFCS V). The recurrence can be seen in up to 30% of the patients depending on the type of the procedure performed and the level of spasticity. It is very important that hips continue to be monitored with radiographs after surgery until skeletal maturity.
These include the common complications seen after hip reconstructive procedures in children with spastic cerebral palsy.
Tuesday, August 1, 2017
Saturday, January 7, 2017
Treatment of hip disorders in children with cerebral palsy
In the previous two posts, I discussed the necessity of hip screening. In this post, the various treatment options are discussed.
Treatment of hip disorders in children with cerebral palsy varies on the age of the child and the degree of hip involvement at the time of treatment. If the hip problem is found in early stages, the treatment would be much easier. Treatment options are usually divided into the following three categories:
1- Preventive procedures: These procedures are suitable for mild degree of hip involvement found in younger children (typically younger than 8 years). This is usually done by surgical release (tenotomy) of the adductor tendons (upper inner thighs) through small incisions. Recovery from the surgery typically takes 4-6 weeks. When performed at early stages of hip involvement, these procedures can result in near normal hip development.
2- Reconstructive procedures: These procedures are performed on children with moderate amount of hip disorders who are typically older than 8 years of age. These procedures involve changing the shape of the bones in the femur and/or pelvis (osteotomy). Recovery from these procedures usually takes more than 3 months.
3- Salvage procedures: These procedure are performed in advanced hip disorders which are not suitable for reconstructive procedures due to the severity of the disease. In these patients, the hip joint is almost completely distroyed by arthritis. These procedures include hip replacement, hip resection, and hip fusion. Outcome of these procedures are inferior to preventive and reconstrive procedures.
The goal of hip screening is to find the hip problems in the early stages so it can be treated with preventive and reconstructive procedures. Hip screening programs are shown to complexly eliminate the need for salvage procedures.
Treatment of hip disorders in children with cerebral palsy varies on the age of the child and the degree of hip involvement at the time of treatment. If the hip problem is found in early stages, the treatment would be much easier. Treatment options are usually divided into the following three categories:
1- Preventive procedures: These procedures are suitable for mild degree of hip involvement found in younger children (typically younger than 8 years). This is usually done by surgical release (tenotomy) of the adductor tendons (upper inner thighs) through small incisions. Recovery from the surgery typically takes 4-6 weeks. When performed at early stages of hip involvement, these procedures can result in near normal hip development.
2- Reconstructive procedures: These procedures are performed on children with moderate amount of hip disorders who are typically older than 8 years of age. These procedures involve changing the shape of the bones in the femur and/or pelvis (osteotomy). Recovery from these procedures usually takes more than 3 months.
3- Salvage procedures: These procedure are performed in advanced hip disorders which are not suitable for reconstructive procedures due to the severity of the disease. In these patients, the hip joint is almost completely distroyed by arthritis. These procedures include hip replacement, hip resection, and hip fusion. Outcome of these procedures are inferior to preventive and reconstrive procedures.
The goal of hip screening is to find the hip problems in the early stages so it can be treated with preventive and reconstructive procedures. Hip screening programs are shown to complexly eliminate the need for salvage procedures.
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