Hip reconstruction
Hip problems are a common feature of the clinical presentation in children with cerebral palsy. Abnormal muscle tone, asymmetrical muscle function, and limited motor control can affect hip development, leading over time to subluxation or dislocation. That is why regular monitoring, imaging studies, and appropriately tailored treatment are so important.
At the Paley European Institute, hip surgery for a child with MPD is planned on a case-by-case basis and is part of a broader treatment and rehabilitation process. Depending on the child’s condition, the goal of treatment may be to improve hip stability, reduce pain, prevent further deformities, and facilitate functioning and rehabilitation.
Hip Problems in Children with MPD—Why Do They Require Monitoring?
Cerebral palsy can affect muscle tone, motor coordination, and the way weight is distributed on the limbs. As a result, the hip joint may not develop properly. The head of the femur may gradually shift relative to the acetabulum, leading first to subluxation and, in more advanced cases, to dislocation.
Therefore, hip problems should not be assessed solely on the basis of whether the child is experiencing pain. Changes may develop gradually, and early detection allows for the timely planning of further treatment.
The American Academy for Cerebral Palsy and Developmental Medicine recommends systematic monitoring of the hip joints in children with cerebral palsy. This includes a clinical examination and radiological evaluation, and the frequency of follow-up visits depends, among other factors, on the child’s age, GMFCS functional level, and the results of previous examinations.
When is hip surgery necessary for a child?
Not every child with MPD and not every hip abnormality requires surgical treatment. The decision to perform surgery depends, among other things, on the degree of deformity, the results of imaging tests, the child’s age, the child’s functional abilities, and the symptoms present.
Hip surgery in children may be considered in cases of progressive subluxation or dislocation, abnormal joint development, or pain. At the Paley European Institute, treatment planning includes a detailed assessment of the patient’s condition and imaging studies, including X-rays and, in select cases, ultrasound or magnetic resonance imaging (MRI).
Proper monitoring is also of great importance. According to the AACPDM, a referral to a pediatric orthopedist is recommended, among other things, for hip pain, femoral head migration exceeding 30%, or hip abduction limited to less than 30 degrees. However, these are criteria for monitoring and determining eligibility for further evaluation, not an automatic indication for a specific procedure.
Bilateral hip reconstruction
In children with MPD, hip problems may occur on both sides. In such cases, treatment may involve bilateral hip reconstruction, which is the simultaneous correction of both hip joints.
The goal of this procedure is to restore the heads of the femurs to as normal a position as possible relative to the acetabula, improve joint stability, and reduce the risk of further deformity. Treating both hips at the same time also allows for symmetry of the entire hip-pelvic complex. At the Paley European Institute, bilateral reconstructions are procedures designed, among other things, to improve hip stability, reduce pain, and make it easier to walk or maintain a seated position.
Hip Reconstruction Without a Cast and Early Rehabilitation
One aspect of the approach used at the Paley European Institute is performing bilateral hip reconstructions without routinely using a postoperative cast. According to information provided by the Institute, early rehabilitation begins as early as the day after surgery.
Limiting immobilization can help maintain range of motion, reduce the risk of contractures and muscle atrophy, and allow for an earlier start to functional rehabilitation. However, this does not mean that every child who undergoes reconstruction follows the exact same rehabilitation course. The range of exercises, positioning techniques, and the pace at which activity is increased must be tailored to the specific procedures performed and the patient’s current condition. As part of the established protocol, rehabilitation begins immediately after surgery, and the hospital stay following bilateral reconstruction is typically 3–4 days.
Over the past five years, we have performed more than 200 bilateral hip surgeries on children with MPD, and the rate of hip stability following treatment was 97% (note that this represents the percentage of stable hips, not the overall success rate of all surgeries in every child with MPD).
Paley European Institute
No casts
Surgery on both hips at the same time
Immediate exercise
Hospital stay: 3-4 days
97% effectiveness
Standard method
Many weeks of immobilization
Two surgeries, longer rehabilitation
Deferred rehabilitation
Hospital stay: 2-3 weeks
Greater risk of complications
Paley European Institute team
We are a team of surgeons specializing in advanced joint reconstruction surgery and limb lengthening and reconstruction surgery. We comprehensively treat patients with orthopedic and neurological problems, especially children with congenital malformations and neuromuscular disorders. Many years of experience in the use of modern reconstructive techniques have allowed us to significantly improve the methods of surgical treatment of children with neurological problems, opening up new prospects for improving their functionality and quality of life.
We specialize in simultaneous multilevel limb reconstructions (SEMLS) and complex hip reconstructions, using both proven and innovative surgical methods. In addition to surgery, we also provide conservative treatment including multi-level botulinum toxin (BTX) injections, as well as minimally invasive procedures such as SPML (Selective Percutaneous Myofascial Lengthening) and PERCS (Percutaneous Muscle Lengthening).
Highlights of our team's achievements in treating patients with neuromuscular disorders:
The introduction of simultaneous bilateral hip instability reconstruction in Poland without the use of plaster dressings, allowing recovery to begin the very next day after surgery, including the use of triple pelvic osteotomies (tPAO). This procedure has been performed successfully in more than 150 patients over the past eight years.
Introduction to practice in Poland of simultaneous multilevel lower extremity reconstructions (SEMLS) with a proprietary recovery program, already realized in more than 50 patients in 8 years.
Introduction of simultaneous muscle lengthening techniques using the PERCS/SPML method. Author's program for multilevel administration of BTX under sedation, with special emphasis on injection into the iliac-lumbar muscle through the abdominal shell and use of a dedicated delordotic corset.
A proprietary program to correct hip contracture using BTX/PERCS and dedicated orthotic supplies (delordotic corset).
A serial lower extremity plastering program using BTX/PERCS/SPML. A program for "tuning up" patients after SDR procedures using PERCS/SPML procedures.
Introducing computerized gait analysis as a standard diagnostic tool in daily medical and therapeutic practice.
Our Doctors Meet the Paley European Institute team
The treatment planning process includes:
Hip reconstruction requires careful planning. At the Paley European Institute, each case is reviewed by a multidisciplinary team that includes, among others, an orthopedic surgeon, a physical therapist, and an orthotist. The team assesses the child’s condition, the potential benefits and risks of the proposed treatment, and plans for follow-up care.
Assessment of the Patient's Condition
A detailed evaluation of your child's condition, taking into account his or her medical history, current symptoms and potential complications. At Paley European Institute, we perform specialized imaging studies (X-ray, ultrasound, sometimes MRI) to accurately plan the procedure.
Selection of treatment method
Selection of appropriate surgical procedures and development of a post-operative care plan tailored to the needs of the individual patient and family.
Preparation for the procedure
Comprehensive preparation of the child and family for the procedure, including education on procedures, expectations and potential complications.
Orthopedic surgery
In the context of cerebral palsy (MPD), orthopedic surgery focuses on correcting bone and joint deformities and treating muscle contractures. Its goal is to improve motor function, reduce pain and facilitate further rehabilitation.
Bilateral hip surgeries
Patients with MPD often develop hip joint abnormalities such as subluxations and dislocations, leading to pain, difficulty in daily activities and the risk of further deformities.
Objectives of the treatment
Improving hip joint stability.
Preventing further deformities and reducing pain.
Improving the function of walking or sitting position.
Scope of treatment
It may involve osteotomy of the pelvis (e.g., Dega, Salter or other types) and/or femur (varus-derotation osteotomy) to improve centration of the femoral head in the acetabulum.
It is often made on both sides to maintain symmetry and avoid uneven load distribution.
Why Paley European Institute?
No casts after surgery - immediate rehabilitation instead of weeks of immobilization.
Simultaneous surgery of both hips - shorter recovery, less stress for the child.
Quick start-up after surgery - the child can sit up as early as the next day.
Advanced treatment - pelvic and femoral osteotomy for best results.
Individually tailored therapy plan - holistic post-operative care
Paley European Institute
Diagnosis and qualification
Detailed imaging studies (X-ray, ultrasound, MRI).
Consultation with a team of specialists: orthopedists, physiotherapists and orthotists.
Modern orthopedic surgery
Osteotomy of the pelvis (Dega, Salter, Pemberton) or femur (VDRO).
Reconstruction and stabilization of the hip joint.
No plaster bandages - immediate introduction of rehabilitation.
Rehabilitation and quick recovery
Exercises start the very day after surgery!
Faster mobilization, no contractures, less risk of complications.
Rehabilitation and patient care after bilateral hip reconstruction
A significant advantage of not wearing a cast is faster rehabilitation, lower risk of complications, and improved joint comfort and mobility. The following is a broad list of advantages associated with the absence of immobilization in a plaster dressing (e.g., the so-called femoroacetabular/spica cast) in children with MPD after bilateral hip surgeries, as well as the benefits of starting early rehabilitation:
Faster startup and rehabilitation
The lack of immobilization in a cast means earlier mobilization of the child, which directly translates into a faster start of improvement exercises, learning to walk or uprighting.
Early exercises promote proper healing of the operated joints, improve blood circulation and prevent contractures.
Lower risk of immobilization-related complications
The use of plaster dressings (especially extensive ones) is associated with the risk of sores or skin abrasions in the areas where the plaster adheres.
The risk of blood supply disorders and nerve compression, which can sometimes cause numbness, pain or swelling, is also reduced.
Prevention of muscular atrophy
Many weeks of immobilization in a cast leads to muscle atrophy (weakening and reduced muscle mass).
The absence or reduction of a cast, combined with immediate rehabilitation, allows the muscles to work actively and maintain strength, which in the long run can have a positive effect on gait pattern and function.
Improved maintenance of range of motion (ROM) in joints
Long-term immobilization often leads to contractures, especially in children with MPD, who already have an increased risk of spasticity.
Early mobilization and rehabilitation help maintain or even improve the range of motion in the hip joints, which is crucial for further motor development.
Child's mental and physical comfort
Children in a cast often experience discomfort, pain, limitations in daily activities (dressing, changing, hygiene, playing).
Reduced immobilization makes it easier for parents to care and allows the child to be more independent and comfortable (for example, the ability to change positions without additional assistance).
Better hygiene and easier care
Maintaining the cleanliness of the hip, perineal and buttock areas is sometimes made much more difficult with a cast covering the hips.
The absence of a plaster dressing makes daily toileting easier and reduces the risk of skin infections or irritation.
Reduced risk of thromboembolic complications
Prolonged immobilization increases the risk of deep vein thrombosis (DVT) and possible embolism (although rare in children, it is still possible).
Earlier activation and exercise promote proper blood flow, reducing the potential risk of these complications.
Easier monitoring of the condition of the operated hips
The absence of a massive dressing allows the doctor to assess the condition of the surgical wound, healing and possible swelling more accurately and frequently.
Facilitates access for physical examination and follow-up imaging studies (X-ray, ultrasound) to assess proper alignment of the femoral head in the acetabulum.
More flexibility in the selection of orthoses
Instead of a cast, orthoses are often used, which can be removed for exercise or daily care, and then put back on as needed.
The ability to adjust hip flexion angles (such as in dynamic orthoses) allows better adjustment of the limb's positioning to the current phase of rehabilitation.
Supporting normal psychomotor development
A child in a cast is more likely to experience delays in acquiring further motor skills (crawling, crawling, walking).
Early initiation of rehabilitation promotes the child's activation of movement, which translates into the development of coordination, balance and strengthening of muscle-nerve bonds.
Effects on later movement patterns
The longer a child maintains a normal or near-normal movement pattern in the post-operative period, the lower the risk of perpetuating unfavorable movement habits.
It is also easier to continue rehabilitation and introduce advanced exercises (e.g. learning to walk with the help of a walker, crutches or a verticalizer) when there are no barriers caused by the cast.
Effective prevention of secondary deformities
Limited muscle activity and lack of joint movement can in some cases accelerate deformity processes (especially in children with MPD, where there is increased muscle tension).
Immediate implementation of rehabilitation helps keep joints in favorable positions, preventing secondary contractures or tendencies to dislocation.
Your most frequently asked questions
That is, What you as a parent should know before making a decision.
In our post-operative management we TOTALLY abandon the use of plaster dressings of the hips. It brings to much harm to the patient. It causes muscle atrophy and perpetuates the abnormal pattern of limb linearity and accelerates the formation of adhesions within the hip joints which are no longer possible to correct conservatively after removing the plaster dressing.
Performing the procedure simultaneously on both sides reduces the total time of hospitalization and rehabilitation, as well as the stress of multiple surgical interventions.
Thanks to modern surgical techniques and individually tailored rehabilitation, patients quickly regain basic motor functions.
Physiotherapy takes off instantly, which promotes proper healing and reduces the risk of complications, giving the best results in terms of restoring function.
Thanks to personalized procedures and a smooth procedure and rehabilitation, children can quickly return to their home environment, continuing their recovery in comfort. Parents are with their young patient all the time in the hospital, escorting them to the operating room and being with their child immediately after awakening.
We provide adequate analgesia: the so-called "3-in-one" (nerve blocks) and epidurals, which effectively reduce pain in children.
Parents receive updates on the progress of the procedure in real time, which minimizes stress and allows them to consciously accompany their child through the treatment process. In addition, everyone receives a package of consultations with a psychologist, both parent and child, who together learn about the hospital and min procedures, through blocks or thorough conversation.
Unique center among the top facilities in the world
Specializing in the surgical treatment of hip deformities in MPD patients.
It is not only the numbers and statistics that set us apart globally, but also the procedures we have developed for dealing with them, including:
An individualized approach to the patient that takes into account both the extent of spasticity, general health and functional goals.
An integrated rehabilitation program that provides early and active incorporation of physical therapy, tailored to the child's current abilities.
Involve parents and caregivers in the treatment process to support the child in further therapy already at home.
As a result, each patient receives maximally tailored treatment that does not end with surgery alone, but includes a holistic path of improvement and long-term follow-up care. The high percentage of successful treatment results confirms the effectiveness of such a structured model of treatment and rehabilitation, and provides an important benchmark for other medical centers around the world.
Photo Gallery
See how we take care of our patients
Challenges, perseverance and hope
Read about our patients
