ABSTRACT
Common problems of the hip in cerebral palsy include adduction deformity, flexion deformity, internal rotation gait and hip subluxation and dislocation. A spastic adduction deformity of the hip may be dynamic due to spasticity of the muscles that adduct the hip or there may be a true contracture of these muscles. The adductor muscles are erased from their origin on the pubic bone and transferred more posteriorly onto the ischium. The rationale of the operation is to abolish the adductor action and enhance the hip extensor power. The first and foremost issue is to differentiate between spasticity and contracture of the adductor muscles. If a contracture is present, surgery is indicated, whereas the initial treatment of spastic adductors is essentially non-operative. If release of the hip flexion contracture is part of the procedure to reduce a spastic hip dislocation, the options for dealing with the iliopsoas tendon include tenotomy and transfer.
