Surgical Procedures Involving the Hips

Children with cerebral palsy may be offered surgery on their arms and/or legs and these procedures include hip muscle releases (including adductor tenotomy and psoas release, hip adductor lengthening, iliopsoas release lengthening and hamstring lengthening) and femoral osteotomy.

Children with cerebral palsy may experience scissoring of the legs. This is where the upper part of the legs and knees hit and sometimes cross, and the hips and knees can stay in a flexed position which gives the impression that the child is crouching. Children with cerebral palsy who have increased spasticity have an increased risk of developing a scissoring of the legs. The tightness of the muscles which pull the legs into this position can cause the ball of the hip joint to become partially or fully dislocated. This can affect the child’s growth and development. It can also be difficult for children with scissoring of the legs to sit in a wheelchair and find comfortable positions when lying down.

Muscle releases can be tailored to each child’s needs and to their degree of spasticity. Certain muscles can be released or lengthened and these procedures reduce the tightness in the treated muscle. This can prevent dislocation in more than two thirds of children and helps children with cerebral palsy to move more easily and to find comfortable positions when sitting or lying down and so significantly improve their quality of life.

The term femoral refers to the bone in the thigh, the femur, and an osteotomy is a term used to describe the removal of a wedge of bone. The procedure also typically involves the placement of a plate to hold the femoral bone at a different angle where it meets with the socket of the hip joint. This is considered major reconstructive surgery and is the most commonly performed reconstructive surgery in children and adolescents.

Femoral osteotomy can help children with cerebral palsy where they have partial or full dislocation of the hip as described above. This is because the dislocation causes damaging effects to the tip of the femur which sits inside the socket of the hip joint. This can cause pain and affect the child’s movement and ability to sit and lie comfortably.

As these procedures are usually performed on children who are still growing, they may need to be repeated where the effects are temporary. The surgery itself will affect the anatomy of the child and so this can potentially cause other problems as a child grows. For femoral osteotomy specifically, there is a risk that the blood supply to the tip of the femur which sits inside the hip socket may be affected and further surgery may be required. As with any operation, there is also a risk of infection, bleeding, failure of the procedure, pain and the need for repeated follow-up procedures.

These surgical procedures are usually covered by government health insurance plans, including MSP. However, a child will need to be assessed for suitability, and their suitability may depend upon the degree of spasticity in their legs and whether their hip joint has been affected by this spasticity. Your child’s health care team will be able to provide medical advice and guidance on whether or not this surgical procedure may be beneficial for your child.