The Unstable Paralytic Hip: Treatment by Combined Pelvic and Femoral Osteotomy and Transiliac Psoas Transfer

Between 1970 and 1985, 26 pelvic and femoral osteotomies and transiliac psoas transfers were performed in one or two stages on 18 patients with progressive hip instability associated with flaccid or spastic paralysis. Average follow-up was 95 months. Twenty hips were located, two were subluxated, and none was dislocated. The acetabular index was 30 degrees preoperatively and 19 degrees at follow-up. The center edge angle was -24 degrees preoperatively and 15 degrees at follow-up. The combination of pelvic and femoral osteotomy and transiliac psoas transfer, now done in one stage, is an effective means of obtaining and maintaining location of the hip in patients with myelomeningocele and cerebral palsy.