Orthopedic surgery is used to treat tight muscles and spasticity related to
cerebral palsy. An incision is made in the skin over the affected muscle. Parts of the muscle are then cut to release the tightness.
After orthopedic surgery:
- Joints that were previously stiff can move more easily. However, the affected muscle may be weak.
- Some people may need to wear a cast or brace to support an area where movements are not under control.
The type of orthopedic surgery done to treat problems from cerebral palsy depends on which muscle groups are affected. Some basic goals are to loosen the:
- Muscles that make the hips turn toward the body (partial release of the hip adductor muscles). This surgery increases hip movement, allowing a child to sit and walk more easily. It also may be done to help prevent hip dislocation in children who are at risk.
- Muscles on the back of the thigh (partial hamstring release). These muscles control the tension in the thigh and around the knee, allowing a child to sit and walk with a more normal posture.
- Tendon at the back of the ankle (Achilles tendon lengthening or heel cord lengthening). This surgery helps a child walk with a flatter foot.
Orthopedic surgery may be considered when a child with CP has:
- A bone or joint deformity that causes pain or interferes with function and is getting worse over time.
- Permanent stiff joints (contracture).
- Dislocated or irregularly functioning joints.
- A spinal deformity that is not improving with other treatment.
- A deformity that makes some caregiving functions, such as bathing, extremely difficult or impossible.
Corrections made during orthopedic surgery may be temporary. As a person grows, the same muscles or other muscles may become tight and cause contractures. Additional surgery may be needed.
Surgery of any kind carries the risk of bleeding, infection, or need for repeated surgery. Orthopedic surgery carries the additional risk that it may resolve some problems only to create more as a child grows and develops.
Doctors do not agree about the best age for children with CP to have surgery. Surgery may be postponed until a child is older than age 2. At that time, the doctor can try to release many tight muscles during the same surgery, instead of releasing only one muscle at a time. Avoiding repeated surgeries has many advantages, such as decreasing the number of times a child needs to go to the hospital, decreasing overall time spent in physical therapy, and less disruption of the child's school and social life.
Before a child has orthopedic surgery, it is important to determine whether he or she will be able to walk after the procedure. The goals for children who will walk differ from the goals for children who will not walk.
Current as of: August 21, 2019
Author: Healthwise Staff
Medical Review: Susan C. Kim, MD - Pediatrics
Kathleen Romito, MD - Family Medicine
Louis Pellegrino, MD - Developmental Pediatrics