Posture improves after femoral extension osteotomy for hip flexion contractures
PRAGUE — Flexion contracture in the hips of pediatric patients due to spastic cerebral palsy, arthrogryposis and other conditions can be challenging to treat. However, a team from the Medical University of South Carolina, in Charleston, U.S.A., found in a study that performing a proximal femoral extension osteotomy was effective in such cases.
Yuehuei An, MD, presented the clinical results of the retrospective study of 8 patients with hip flexion contractures that averaged than 46º and discussed key aspects of the surgical technique during the SICOT XXV Triennial World Congress 2011, here.
Most of the cases were carried out by Richard Gross, MD, who was in the audience.
“All patients were doing well at an average 14 months follow-up with improved standing posture and gait,” An said.
He noted the procedure has previously been used to treat other orthopaedic conditions. For the posteriorly-based closing wedge osteotomy done at the intertrochanteric level in these cases, a lateral incision and a blade plate fixed with screws to stabilize the osteotomy were typically used.
“The postoperative care was patients getting PT (physical therapy) the next day and weightbearing as tolerated with the aid of a walker or crutches,” An said.
The study involved evaluating several factors postoperatively, including correction of the sacral femoral angle radiographically, assessment of the patients’ gait and posture and identification of complications.
At 14 months postoperatively, when their last follow-up examination was done, the improvement in the patients’ sacral femoral angles averaged about 33°, An noted.
Despite these good results, he cited the few cases in the series and the lack of family/patient functional scoring among the study’s limitations.
During the paper’s discussion, Gross answered some questions and noted he uses the Tönnis test to check the sacral femoral angle while the patient is under anesthesia and has successfully corrected hips with up to 60º contracture with this method.
- An Y, Gross R. Proximal femur extension osteotomy for treatment of flexion contracture of the hip. Paper #29304. Presented at the SICOT XXV Triennial World Congress 2011. Sept. 6-9. Prague.