Complications of Hip Treatment in Children with Cerebral Palsy

Abstract

Children with cerebral palsy can have multiple complications in the course of managing the hips during growth. Most of these complications are mild and delay the full recovery, but a few cause a long decrease in physical function and pain. Late diagnosis or delayed treatment is the most severe complication because it allows the hips to develop arthritis which makes the outcome of subsequent treatment less good. Other complications include the possibility of a wound infection; most heal with wound management and antibiotics with no impact on the eventual outcome. Prolonged pain after hip surgery may be due to the prominent hip plate, from arthritis as the hip joint is healing, from heterotopic bone formation, or from an undiagnosed fracture. The treatment is based on developing a good diagnosis of the pain and addressing hip pain with steroid injections if it persists for 3–4 months. Some of the children have problems eating and sleeping at night. This is best managed with nonnarcotic pain medication and amitriptyline hydrochloride (Elavil). Fractures after hip surgery may occur and are more common if the child was placed into a hip spica cast, which is seldom needed. Identifying the fracture and doing appropriate treatment will provide a good outcome. Nonunion and delayed union of the osteotomy, avascular necrosis, and heterotopic bone formation are rare complications that can usually be managed with temporary activity restriction and treating the pain.