Four decades after a reverse osteotomy, treatment of chronic degenerative hip pain in a male patient with cerebral palsy
Due to aberrant gait patterns brought on by spasticity, cerebral palsy (CP) patients typically need surgical hip procedures in their early adult years. These conditions are typically distinguished by substantial movement limits. In this instance, a male patient with CP had right proximal femoral open reduction internal fixation (ORIF) and reverse osteotomy for right hip subluxation when he was still a teenager. Total hip arthroplasty (THA) or ORIF with reverse osteotomy patients with CP frequently need a subsequent revision.The patient’s plate and screw construction (hardware) was previously predicted to have a 10-year lifespan. The patient first presented with crippling persistent bilateral hip pain 44 years later, necessitating the use of a cane for ambulation. Research on ORIF and reverse osteotomy follow-up in CP patients over a 30- to 50-year period.
At 44-year follow-up revealed postoperative alterations in the right femur, including intact hardware, bilateral acetabular dysplasia, a right femoral stress fracture, advancement of hip arthritis, and a right iliopsoas bursitis. Surgery to replace the hardware was not advised. With careful management, a gradual restoration of function was accomplished over a 14-month period. This case indicates that chronic degenerative alterations, related bursitis, and function loss in patients with CP-induced gait problems can be improved with physical therapy (PT), exercise, and infrequent non-steroidal anti-inflammatory drug (NSAID) use.Several decades after receiving ORIF and osteotomies, these improvements are possible. Without additional surgical treatments, this course of treatment was successful in enhancing the patient’s quality of life.
Introduction
Gait abnormalities brought on by cerebral palsy (CP) frequently call for surgical intervention in young adults [1]. Due to contractures and stiffness, patients with CP usually have a restricted range of motion at the hip joint [2]. Most frequently, CP results in hip dysplasia due to the stiffness of the hip flexor and adductor muscles and the weakening of the abductor muscles, which delays weight bearing. This results in gradual dysplasia of the acetabulum and abnormalities of the proximal femur [2]. Risks for coxa valga subluxation, which frequently occurs in early adulthood,muscle imbalances caused by increased femoral anteversion [3]. Although total hip arthroplasty (THA) has grown more prevalent, surgical treatment was usually advised in early adulthood with osteotomy and proximal femoral fixation [1]. There aren’t many published case studies on post-surgical patients’ long-term outcomes for intervals longer than 10 years [4].
Conservative therapy, such as bracing, botulinum toxin A injections, and heel lifts, can be used to address late-adult persistent hip discomfort and accompanying gait abnormalities in people with CP. It might be necessary to undergo surgical reconstruction or hardware revision if these measures are insufficient to enhance gait and quality of life [3,5]. 44 years after the initial surgical operation, the patient in this case continued to endure chronic hip pain and gait issues. The patient’s condition created difficulties because there was insufficient evidence to support aggressive surgical intervention, and pharmaceutical pain management was insufficient to control the patient’s agony.
