DDH and Cerebral Palsy Hip - Complex Reconstruction

Clinical Scenario

An 8-year-old girl with spastic diplegic cerebral palsy (GMFCS level IV) presents with progressive right hip pain and difficulty with sitting. X-rays show bilateral hip subluxation with migration percentage 60% on the right and 40% on the left. The right hip has early signs of femoral head deformity.

Questions & Model Answers

What is the natural history of hip displacement in CP and when is intervention indicated?

Describe the surgical approach for hip reconstruction in this patient.

What if the femoral head is severely deformed with established arthritis?

Describe hip surveillance programs in cerebral palsy and their importance.

What is the postoperative management and potential complications after CP hip reconstruction?

How does GMFCS level influence decision-making and what are long-term outcomes?

Exam Tips

Opening Statement: This child with spastic diplegic CP (GMFCS IV) has bilateral hip subluxation requiring intervention. The right hip with MP 60% and pain requires reconstruction with combined femoral and pelvic osteotomy.

Common Pitfalls:

Don't delay reconstruction until salvage is only option
Hip surveillance programs essential in CP
Consider both hips - bilateral surgery may be appropriate