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.