A single-skin incision extended anterolateral approach to the hip for treatment of hip problem in cerebral palsy patients

Abstract

Cerebral palsy often carries a high risk of hip involvement, especially in patients with a higher degree of body involvement. Hip subluxations and dislocations are commonly seen in non-ambulatory patients. We report on a single skin incision anterolateral approach to the hip that provides excellent visualization of all relevant anatomical structures and allows for a broad range of operative procedures needed to complete the San Diego operation. From 2005 to 2020, 50 patients (56 hips) were treated using the San Diego procedure. There were 22 male and 28 female patients, with 28 dislocated and 28 subluxated hips. The average patient age at the time of surgery was nine (range, 4 – 22 years). A San Diego or Dega pelvic osteotomy was done in 49 hips, and seven hips underwent a Brunner-type pelvic osteotomy. The mean follow-up was seven years (range, 2 – 13 years). The median preoperative AI measured at 40° (range, 35° – 50°). The median postoperative AI at the time of the most recent follow-up was 22,5° (range, 5° – 40°). The average head migration index at the last follow-up was 10% (range, 0% – 60%). Two infections, three recurring adduction contractures, four redislocations, one fracture, and one pseudarthrosis were encountered. All patients were eventually able to sit pain-free, with significantly better sitting balance.

Keywords

• cerebral palsy
• hip joint
• osteotomy