Femur
Multiplanar deformity
- worsend by previous surgery
- may require osteotomy
Acetabulum
Dysplasia often present
- not as severe as in DDH
LLD
Can be significant
Abductors
Have been short for long time
- difficult to restore length
Extremely difficult
- goals of rehab must be realistic
- limited number of donors
- static procedures more prominent
- fusions, tenodesis and capsulodeses must be used
EIP to APB and EPL
Optimize cement-bone interface
Cement mantle free of defects
Minimum 2 mm thickness
Femoral component centred in cement mantle
Swedish Joint Registry
Reflection All Poly / Spectron 92% 10 year
Rule out infection
Assess rotator cuff / bone stock preoperatively
Approach
- difficult / scarring +++
- very difficult to restore any loss of ROM
Removal of prosthesis
Glenoid
- may not be able to revise
Humeral component
- long stem
Rule out infection
- CRP / ESR
- ultrasound or xray guided aspiration
Scoliosis 10 to 15 x more common in patients with spastic quadriplegia than spastic diplegia
Typically
- spastic quadriplegic patient
- long C shaped curve
- lumbar apex
- progressive past maturity
- pelvic obliquity / dislocated or subluxed hips
- can extend into cervical spine
- high risk of respiratory compromise
Sitting in wheelchair
Hygiene
Rotator cuff
- often deficient
Bone stock
- often deficient
Glenoid
- often posterior version
1. TSR
Indications
- cuff intact
Decreased tone
- Polio
- Down's syndrome
- spina bifida
Increased tone
- cerbral palsy
- Parkinson's
- CVA
Rare
- case reports only
Acetabular dysplasia not uncommon in this group
Results
Severe LBP
- most common indication
Ipsilateral knee pain
- less beneficial
Malposition
- especially abduction
Absent abductor mechanism
Flail
Active infection
Insufficient bone stock
LLD
1. Lower limb
All walk
- Ankle > knee > hip
Ankle
- most require operations for ankles
LLD
- unilateral underdevelopment
- LLD 0-5cm (average 2cm)
2. Lower limb
- one handedness
- decrease movement in swing
- astereogenesis
- usual upper limb contractures