A Randomized Control Trial of Hip Dislocation Techniques for Pediatric Patients With Cerebral Palsy
Hip Dysplasia, Cerebral Palsy
About this trial
This is an interventional treatment trial for Hip Dysplasia focused on measuring cerebral palsy, randomized controlled trial, hip dislocation, hip subluxation, patient centered outcomes, cost effectiveness analysis
Eligibility Criteria
Inclusion Criteria:
- 7-21 years of age
- Painful irreducible Hip dislocation and cerebral palsy diagnosis
- GMFCS 4 or 5
Exclusion Criteria:
- GMFCS 1-3
- Decline to participate
- Outcome scales not validated in patient language.
- Candidate for total hip replacement
Sites / Locations
- Phoenix Children's Hospital
- Miami Children's Hospital
- Boston Children's Hospital
- Children's Hospital of Michigan
- Hospital for Special Surgery
- British Columbia Children's Hospital
- The Hospital for Sick Children
Arms of the Study
Arm 1
Arm 2
Active Comparator
Experimental
Proximal Femoral Resection Arthroplasty
Subtrochanteric Valgus Osteotomy
A 10-12 cm direct lateral incision will be made distally from the greater trochanter. The abductors of the hip are detached with sharp dissection. A capsulotomy is performed. The femur is exposed in a supra-periosteal manner (2 cm distal to the lesser trochanter) at the level of the ischium; transverse osteotomy will then be performed. The joint capsule will be sutured to itself. The iliopsoas tendon and the abductor tendons are attached to the capsule. The quadriceps will be brought around the proximal femoral stump and sutured to medial tissues.
A 10-12 cm direct lateral incision will be made distally from the greater trochanter. The medial half of the abductors may be incised off the greater trochanter for repair. The femoral head is resected at the base of the neck. The ligamentum teres is incised off the head and preserved. A lateral closing wedge osteotomy is performed below the lesser trochanter. 3.5 or 4.5 5 hole locking/non-locking surgeon-contoured plate ( 45⁰) will be used to stabilize the osteotomy. Femoral torsion will be corrected. The psoas tendon will attach the ligamentum teres to the lesser trochanter. The anterior and posterior capsule is sutured together creating interposition tissue. If the ligamentum teres was sutured to the lesser trochanter, the capsule will not close, but will be covered by the psoas tendon.