Hip reconstruction is a complex surgical procedure performed in cases of hip dislocation in patients with Cerebral Palsy.
What does hip reconstruction mean?
This procedure consists of:
- return the femoral head to its place (=hip reduction) and
- adjust the bones that make up the hip itself (osteotomies of the femur and pelvis) in order to reduce the risk of the hip dislocating.
This is a complex surgical procedure and must be performed in experienced centers.
Hip reconstruction: 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.
Hip reconstruction: what the procedure consists of?
The surgery involves several stages that are performed in the same procedure.
- Proximal femoral osteotomy: The uppermost portion of the femur is cut and bent (varus, derotation) so that it is more correctly oriented. The correction is secured with a modern metal plate. Shortening is generally associated with this procedure to reduce tension.
- Pelvic osteotomy (Dega osteotomy, etc.): the acetabulum (i.e. the part of the pelvis where the femoral head must be accommodated) is made less oblique, so that the head of the femur is more stable.
- Open reduction: the joint is opened, cleaned, and the femoral head is repositioned correctly. The capsule is sutured under tension to increase stability (capsulorrhaphy).
Hip reconstruction: are all surgical steps always necessary?
No, in less severe cases, only part of the procedure is sufficient. It’s important to have experience in understanding when it’s sufficient to limit yourself to a part of the procedure and when it’s not.
Hip reconstruction: Is a cast necessary? Can physical therapy be started?
After hip reconstruction surgery for cerebral palsy, it’s generally not necessary to use a cast. A positioning brace is sufficient.
Rehabilitation begins within the first few days after surgery: the patient is put back in a wheelchair within a few days.
Hip reconstruction or femoral resection?
Hip reconstruction has superior results to femoral resection, so it is important to contact centers that are able to reconstruct even the most compromised cases.
Femoral resection involves cutting the uppermost portion of the femur and removing it completely, to prevent it from impacting the pelvis and causing pain. This procedure is often recommended as a simple solution, but in reality, it doesn’t guarantee pain relief and can also expose to other complications. For this reason, it should be reserved for extreme and specific cases. In most cases, hip reconstruction is still possible with adequate experience.
For many years, our group has been working to spread these concepts among professionals who care for patients with Cerebral Palsy.
Hip reconstruction: Is there a risk of recurrence?
If the reconstruction surgery is performed properly, the risk of recurrence is low.
The risk is higher if the surgery is performed on young children. In other words, as they grow, there may be a tendency for further deterioration. As we often explain, this is not a good reason not to perform the surgery: it’s better to correct the dislocation while the situation is manageable, rather than wait and end up with disastrous cases of painful hips with damaged femoral heads that can no longer be restored.
Can fibrotomy have the same results and correct hip displacement?
Multiple fibrotomy (see fact sheet) cannot resolve hip dislocations. Unfortunately, some of the groups performing multiple fibrotomies lack experience in hip reconstruction surgery.
Many families come to our attention after having undergone repeated multiple fibrotomies without anyone ever considering or treating their children’s hip dislocation.
It is important to inform families that fibrotomies can be combined with hip surgery by visiting centers that are able to perform both procedures.