Dega Osteotomy in Cerebral Palsy Patients – What Is The Key To Success?

Background: Much has been written about hip procedures for the treatment of spastic hip dislocation. However, to date, there are no clear guidelines or consensus regarding which procedure will most benefit a specific CP patient.

Purpose: The purpose of this study was to outline common denominators for successes, as well as for failures, of hip containment after Dega osteotomy in CP patients.

Methods: This is a retrospective study. We reviewed records of all CP patients who underwent surgery for hip dislocations, with a pelvic osteotomy, between the years 2007 and 2017, in two medical centers. Demographic, as well as clinical examination records and radiographic data was reviewed from immediate pre-operative period, immediate post operatively, and at last follow up in our clinic. Clinical success was considered a pain free hip, with no hygiene problems. Radiographic failure was considered a migration index of more than 50%.

Results: A total of 52 patients underwent pelvic osteotomies for hip dislocation or subluxations in this time period. Of them, 24 had a Dega osteotomy, 16 had a Chiari osteotomy and 12 had a Shelf osteotomy.

Of the patients that had Dega osteotomy, 1 patient died from unrelated cause within 5 months from the operation, and was not included in the data.

A total of 23 patients were reviewed. All patients were GMFCS III to V. Four patients had bilateral Dega osteotomies, and the remaining a unilateral osteotomy. All patients had concomitant soft tissue and femur procedures.

Fifteen patients had a good outcome, one patient had a fair outcome, one patient had a good radiological outcome but a poor clinical outcome, and seven patients had poor outcomes, necessitating another surgical procedure.

Failures occurred both in ambulatory and in non-ambulatory patients. Two failure occurred in a contralateral side in patients that underwent bilateral femur osteotomies and unilateral Dega osteotomy.

Discussion: There can never be a single reason for a pelvic osteotomy to fail in a CP patient. However, greater spasticity, the development of a scoliosis, and inadequate achievement of intra-operative coverage were the leading causes of failure in this case study.

Conclusions: We conclude that bilateral pelvic osteotomies should be considered in the more spastic patients. Stricter approach should be taken to the treatment of developing scoliosis in a patient that is a candidate for hip containment surgery, or has underwent such procedure.