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CC BY-NC-ND 4.0 · Rev Bras Ortop (Sao Paulo) 2021; 56(02): 244-250
DOI: 10.1055/s-0040-1713391
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Spastic Hips in Cerebral Palsy – Retrospective Study of Salvage with the McHale Procedure[*]

Article in several languages: português | English
Helder Henzo Yamada 
1   Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas, Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brasil
,
Dante Galvanese Amato Neto 
1   Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas, Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brasil
,
Juliano Mangini Dias Malpaga 
1   Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas, Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brasil
,
Patricia Maria de Moraes Barros Fucs 
1   Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas, Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brasil
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Abstract

Objective To perform a retrospective and cross-sectional assessment to determine the pain and positional improvement of all patients with spastic cerebral palsy (CP) and severe hip deformity who underwent a McHale procedure in our center. A second objective was to analyze the potential complications from the procedure.

Methods All consecutive patients treated between 1995 and 2017 were analyzed. Clinically, the patients should present pain on hip mobilization, difficulty in positioning for sitting and hygiene care, and medical records with complete data; functionally was assessed through the Gross Motor Function Classification System (GMFCS). In the preoperative radiographs, we analyzed the migration percentage (MP), the type of deformity according to the Melbourne Cerebral Palsy Hip Classification Scale (MCPHCS), and the type of deformity of the femoral head. After the surgery, we assessed the proximal migration of the proximal femoral fragment, implant changes and/or failure, and potential heterotopic ossification. The outcomes were reported as successful (D1) in patients presenting remission of pain, painless mobility, and improved positioning, or unsuccessful (D2) in those presenting procedural failure that required a new surgery.

Results In total, 47 patients (53 hips) were treated. Functionally, 43 patients were classified as GMFCS V (91%), 3 as GMFCS IV patients (6%), and 1 as GMFCS III (2%). The mean age was 13 years and 2 months. The follow-up ranged from 1 year to 15 years and 4 months, with an average of 4 years and 8 months. A total of 36 patients (41 hips) presented successful (D1) outcomes after the McHale procedure, corresponding to 77% of our cases, whereas 11 (23%) cases had unsuccessful (D2) outcomes.

Conclusion The McHale procedure is a treatment option for GMFCS IV and V, but we must be aware of the potential complications.

Keywords

cerebral palsy - hip/deformities - hip/surgery

* Study performed by the Neuromuscular Diseases Group, Orthopedics and Traumatology Department, Faculdade de Ciências Médicas da Santa Casa de São Paulo, Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil.




Publication History

Received: 17 September 2019

Accepted: 15 April 2020

Article published online:
22 September 2020

© 2020. Sociedade Brasileira de Ortopedia e Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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