Cafè door procedure

Café door procedure or VDRO osteotomy for hip displacement in Cerebral Palsy?

Many families from USA and all over the world come to us with this question: Café door or VDRO/VRO osteotomy for hip displacement in Cerebral Palsy?

Café door procedure: what is it ?

Cafè door is a surgical procedure described and advertised in the United States by Dr Nuzzo for the treatment of dislocated hips in patients with cerebral palsy.
Cafè door is described as the optimal solution to overcome the limits of the classic interventions performed in these cases, in particular to overcome the failures linked to VDRO osteotomy.

Café door and SPML (Selective Percutaneous Myofascial Lengthening)

Dr Nuzzo was one of the proponents of SPML in the USA, criticizing traditional surgery for cerebral palsy by recommending SPML. Likewise he criticized traditional surgery (VDRO, osteotomies, etc.) suggesting the use of Café door procedures.

OrthoChildren Center (Bologna, Italy) is an experienced center for SPML surgery: see the related fact sheet

Café door: the procedure

The Café door procedure for dislocated hips in Cerebral Palsy is described on the web by the authors themselves. Although it tries to differentiate itself from traditional procedures, in reality the Cafè door procedure involves many steps similar to traditional techniques:

• the café door procedure similarly includes a proximal femur osteotomy procedure with femur redirection (so it’s actually a VDRO too)
• The synthesis of the cafe door osteotomy is performed with an intramedullary nail (a Rush pin) inserted from the neck of the femur, which represents a less stable synthesis than the more modern techniques of synthesis with stability plates, which guarantee greater safety and stability
• The Cafe door procedure includes an osteotomy above the acetabulum, analogous to those of traditional techniques
• Other points described in the method (shortening of the iliac wing, for example) are points commonly used by surgeons expert in CP hip reconstruction procedures and not original procedures

Café door procedure: the results

The results of the Cafè door procedure, like those of the SLOB procedure, are not reported in any international scientific work. The only results described are reported on the websites of the authors themselves.

In general, effective techniques for treating any condition, over the years, are described in international scientific reviews and the results are published worldwide. This did not happen for this procedure.

Café door procedure or VDRO osteotomy for the hips of CP patients?

Authors who suggest performing a Cafe door procedure instead of a traditional VDRO procedure criticize traditional techniques primarily for two reasons:

• Long time for recovery
• Results not always satisfactory

For both of these points we must make some clarifications:

• Recovery time depends on the procedure performed (for example recovery after a simple VDRO is quicker than after a complete reconstruction) and the stability of the surgery performed (which often depends on the experience of the surgeon). In our center, for example, in most cases we no longer apply spica casts (nor skin traction or similar) for these operations and we begin rehabilitation immediately. Patients quickly return to the sitting position and also standing if indicated. In this way we avoid complications related to spica casts, which are still applied in many centers.
• The results of the reconstruction techniques are proportional to the surgical experience of the Orthopedic center. High-level centers have very high success rates. OrthoChildren Center (Italy) is an experienced center. Many patients come from abroad to perform these procedures

Go to the reconstruction techniques sheet

VDRO and reconstruction for hip displacement in CP: our experience

Dr. Lampasi and his OrthoChildren team are among the most experienced international centers in this type of procedure, having treated numerous cases. The results have been shared at national and international conferences.

Over the years, Dr. Lampasi has performed this procedure at the Rizzoli Orthopedic Institute in Bologna, the Meyer Children’s Hospital in Florence (where he founded the Neurorthopedic Specialistic Center), and at various public and private Italian hospitals, also providing consultancy and training to other pediatric orthopedic surgeons.

Modern management principles are applied, learned from the UKBB School in Basel (Switzerland) of Professor Reinald Brunner, one of the Masters of Neuroorthopedics worldwide, with whom Dr. Lampasi has collaborated for many years, which allow us to limit the time of immobilization and optimize the results.

Go to the fact sheet: reconstruction procedures for hip displacement in CP