Surgery on Patients with Cerebral Palsy

Dr Stening has been performing lower limb surgery on patients with Cerebral Palsy (CP) since completing his fellowship at Royal Children’s Hospital Melbourne under Prof Kerr Graham in 2000. He is a VMO at Sydney Children’s Hospital Randwick where most of the surgeries are performed.

Lower limb surgery may be recommended when patients become unresponsive to physiotherapy, botox treatment or may be having difficulty with orthotic compliance and as a consequence is affecting their ability to mobilise.

The type of surgery varies considerably.

Patients who are non ambulatory ie Gross Motor Functional Classification System (GMFCS) 4 /5 generally have problems with hip subluxation that may progress to complete dislocation. Dislocated hips particularly in patients with significant spasticity can become painful making sitting and sleeping problematic. Rehabilitation physicians at Sydney Children’s monitor these patient’s hips with pelvic Xrays according to the Australian hip surveillance guidelines and will refer to Dr Stening if the hip deteriorates. Surgery generally involves making an osteotomy of the upper end of the femur to relocate the hip. Dr Stening will discuss the surgery in more detail at the time of consultation.

Ambulatory CP patients (GMFCS 1- 3) generally require different types of surgeries involving bony osteotomies, muscle lengthening, tendon transfers or joint fusions. The exact combination of surgery depends on recommendations from the gait lab. Gait lab meetings are held monthly in combination with Westmead Children and John Hunter hospitals CP management teams. Biomechanists , rehabilatation physicians, physiotherapist and orthopaedic surgeons are in attendance. Clinical examination under anaesthesia also contributes to the final decision on type of surgery performed.

Once a date for surgery has been confirmed a pre surgical meeting will be arranged with the family involving physiotherapist, occupational therapist and social worker to prepare the family for the expected post- operative journey in particular to discuss equipment, orthotic needs and expected rehabilitation program.

Dr Stening generally reviews the patient after discharge at 6 weeks, 12 weeks, 6 months and 1 year to monitor their progress and make recommendations re rehab, orthotic use etc. A repeat gait analysis is arranged one year post operatively to assess the outcome of surgery and to make recommendations regard further treatment.