Postural and gait abnormalities caused by hip-flexion deformity in spastic cerebral palsy. Treatment by iliopsoas recession.

Analysis of the gait patterns of twenty-five children with spastic cerebral palsy revealed that there were three patterns: (1) hip flexion-internal rotation with flexed knees, (2) hip flexion-internal rotation with hyperextended knees, and (3) hip flexion-internal [See table in the PDF file] rotation with normal knee function. Iliopsoas recession was performed on all twenty-five patients, with additional procedures done at the same time based on the preoperative analysis as follows: In the first pattern, iliopsoas recession and semitendinosus transfer or tenotomy and semimembranosus lengthening; in the second pattern, iliopsoas recession and rectus femoris release; in the third pattern, iliopsoas recession only. After release the internal rotation of the hip gradually decreased in the majority of patients, most of the hip-flexion deformity was corrected, and the excessive lumbar [See table in the PDF file] lordosis which had developed after hamstring tendon transfer or tenotomy was obviated. This combined surgical approach resulted in an improvement in walking without a compromise of function in the majority of the children.