Surgical reconstruction of hip subluxation and dislocation in children with cerebral palsy

Objectives: This study aims to review the efficacy of femoral varus derotation osteotomy (VDRO) and Dega transiliac osteotomy in the treatment of hip subluxation and dislocation of cerebral palsy (CP) patients. Patients and methods: This retrospective study included 25 hips of 22 CP patients (9 males, 13 females; mean age 8.7 years; range, 4 to 18 years) who were operated due to hip subluxation and dislocation between July 2010 and December 2015. The mean follow-up period was 36.1±10.4 months (range, 20 to 65.6 months). Femoral VDRO and Dega transiliac osteotomy were performed in all cases. None of the patients were administered cast immobilization postoperatively. Patients were evaluated clinically with gross motor function classification system preoperatively and at the follow-up period. Acetabular index (AI), migration percentage (MP), and neck-shaft angle (NSA) were measured and documented by pelvic radiographs taken pre- and postoperatively and at the follow-up period. Intraand postoperative complications were recorded. Results: Gross motor function classification system scores improved in 16 patients. Mean AI was 33.2° preoperatively and 20.4° postoperatively. In preoperative period, MP and NSA were 72.7% and 160°, respectively, which improved to 24.3% and 130°, respectively, postoperatively. The postoperative improvement in AI, NSA and MP were statistically significant (p 0.001). We performed revision surgery due to implant failure in two patients and detected hip subluxation due to increased pelvic obliquity in one patient who had thoracolumbar scoliosis. Conclusion: In CP patients, reconstruction of hip subluxation and dislocation with femoral VDRO and Dega transiliac osteotomy establish femoroacetabular congruency. Without any cast immobilization, early physical therapy is encouraged for immediate recovery. © Turkish Joint Diseases Foundation, 2018

Femoral derotation osteotomy in children with cerebral palsy using the pediatric proximal femoral nail

We designed a pediatric proximal femoral nail (PPFN) to overcome fixation method-related complications when performing femoral derotation osteotomy in cerebral palsy patients. Preliminary results of cerebral palsy patients who underwent femoral derotation osteotomy fixed using PPFN to treat in-toeing were evaluated. Sixteen patients with a mean age of 10 years were included. Mean follow-up duration was 36 months. There was no significant difference in the follow-up neck-shaft angle and articulotrochanteric distance values (P = 0.2 and 0.3). PPFN provides stable fixation, early weight-bearing, reduces soft-tissue disruption while limiting the complications due to fixation technique

Matrix-induced autologous mesenchymal stem cell implantation versus matrix-induced autologous chondrocyte implantation in the treatment of chondral defects of the knee: a 2-year randomized study

Cell-based strategies that combine in vitro- expanded autologous chondrocytes with matrix scaffolds are currently preferred for full-thickness cartilage lesions of the knee a parts per thousand yen2 cm(2). Although this approach is reasonable, continuing advances in the field of cartilage repair will further expand the options available to improve outcomes